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Prescribing Guideline Significantly Reduces ED Prescriptions for Opioids

PHILADEPHIA – Are opioid prescribing guidelines a valuable tool or just another bureaucratic interruption to slow down care in the emergency department?

The former, it would seem. According to a recent article in the Journal of Emergency Medicine, an opioid prescribing guideline at Temple University Hospital in Philadelphia had an immediate positive effect on reducing opioid prescribing rates for minor conditions and chronic non-cancer pain in an acute care setting.

With emergency departments a common target for opioid drug-seekers, physicians struggle to maintain a balance between providing appropriate analgesia for patients without creating or exacerbating drug dependence, according to the study authors.

After the U.S. Department of Health and Human Services recommended that pain management guidelines and the clinical decision support tools be created, Temple University Hospital (TUH) and Temple University Hospital-Episcopal Campus (TUH-Episcopal) complied.

"The impact of this type of guideline had never been studied in an acute care setting," said principal investigator Daniel del Portal, MD, FAAEM. "We hypothesized that the rate at which opioids were prescribed in the emergency department for dental, neck/back, and chronic pain would decrease after adoption of the guideline. We also hypothesized that physicians would support the use of the guideline."

For the retrospective observational study, which compared the rate of opioid prescriptions for dental, neck/back, and chronic non-cancer pain before and after adoption of the guideline in January 2013, researchers used data from 13,187 patients aged 18 years or older who met the diagnosis criteria and were discharged from the ED at the two Temple hospitals. In addition, a survey was administered to emergency medicine physicians who were practicing in the two EDs.

According to the study, the rate of opioid prescribing decreased from 52.7% before the guideline to 29.8% immediately after its introduction, and to 33.8% 12 to 18 months later. The decrease in opioid prescriptions was across the board, the authors report, observed in all diagnosis groups and age groups reviewed.

With nearly 100% of the physicians surveyed saying they supported the voluntary guideline, most reported that the guideline had facilitated discussions with patients when opioids were being withheld. In addition, nearly three-quarters of respondents reported encountering less hostility from patients since adoption of the guideline.

"Emergency physicians and other acute care providers can use various tools to promote the rational prescribing of dangerous opioid medications," del Portal added in a Temple press release. "In contrast to electronic prescription drug monitoring programs, which show promise but require significant infrastructure and regulation (and are as yet unavailable to prescribers in Pennsylvania), an easily implemented guideline empowers physicians and protects patients from the well-documented dangers of opioid misuse."