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How does mandatory use of a prescription drug monitoring program change the prescribing practices for patients undergoing elective general surgery?
In this pre-post cohort study of 1057 patients, prescribing practices were compared before and after New Hampshire legislation mandating the use of a prescription drug monitoring program that took effect January 1, 2017. There was no significant change in the rate of opioid prescriptions written or the mean number of pills prescribed.
It seems that efforts to curb overprescribing of opioids should be evidence based and should show clinical benefit prior to mandatory implementation, and that patients undergoing elective surgical procedures should be considered differently when developing opioid legislation.
Most states have adopted the routine use of a prescription drug monitoring program (PDMP) to curb overprescribing of opioids. The American College of Surgeons promotes the use of these programs as a “guiding principle to curb the opioid epidemic.” However, there is a paucity of data on the effects of the use of these programs for surgical patient populations.
To determine the association of the mandatory use of a PDMP with the opioid prescribing practices for patients undergoing general surgery.
Design, Setting, and Participants
A prospective observational cohort study was conducted at an academic hospital in New Hampshire among 1057 patients undergoing representative elective general surgical procedures from July 1, 2016, to June 30, 2017.
New state legislation mandated the use of a PDMP and opioid risk-assessment tool for all patients receiving an outpatient opioid prescription in New Hampshire beginning January 1, 2017. The electronic medical prescribing system was modified to facilitate and support compliance with the new requirements.
Main Outcomes and Measures
Change in opioid prescribing practices after January 1, 2017, and time to complete PDMP requirements.
Among the 1057 patients (569 women [53.8%] and 488 men [46.2%]; mean [SD] age, 56.8 [15.4] years), the percentage of patients prescribed opioids after surgery did not decrease significantly (429 of 536 [80.0%] before the new requirements vs 401 of 521 [77.0%] after the requirements; P = .29). The mean number of opioid pills prescribed decreased from 30.8 to 24.0 (22.1%) in the 6 months prior to the mandatory PDMP requirement; the rate of decrease was actually less (from 22.8 to 21.9 pills [3.9%]) in the 6 months after the legislation. These new requirements did not identify any high-risk patients who subsequently were not prescribed opioids. The query and opioid abuse risk calculator together took a median time of 7 minutes (range, 2-17 minutes) to complete.
Conclusions and Relevance
A mandatory PDMP query requirement was not significantly associated with the overall rate of opioid prescribing or the mean number of pills prescribed for patients undergoing general surgical procedures. In no cases was a high-risk patient identified, leading to avoidance of an opioid prescription. A PDMP can be a useful adjunct in certain settings, but this study found that it did not have the intended effect in a population undergoing elective surgical procedures. Legislative efforts to mandate PDMP use should be targeted to populations in which benefit can be demonstrated.
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Accepted for Publication: May 13, 2018.
Corresponding Author: Richard J. Barth Jr, MD, Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756 (firstname.lastname@example.org).
Published Online: August 22, 2018. doi:10.1001/jamasurg.2018.2666
Author Contributions: Dr Barth had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Stucke, Mathis, Hill, Barth.
Acquisition, analysis, or interpretation of data: Stucke, Kelly, Mathis, Barth.
Drafting of the manuscript: Stucke, Mathis, Barth.
Critical revision of the manuscript for important intellectual content: Stucke, Kelly, Hill, Barth.
Statistical analysis: Stucke, Kelly, Mathis.
Administrative, technical, or material support: Mathis.
Supervision: Mathis, Hill, Barth.
Conflict of Interest Disclosures: None reported.
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