Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

Abstract

Purpose Prescription drug monitoring programs (PDMPs) have been established to combat the opioid epidemic, but there is no data on their efficacy in children. We hypothesized that a statewide PDMP mandate would be associated with fewer opioid prescriptions in pediatric surgical patients. Methods Patients < 18 undergoing inguinal hernia repair, orchiopexy, orchiectomy, appendectomy, or cholecystectomy at a tertiary children’s hospital were included. The primary outcome, discharge opioid prescription, was compared for 10 months pre-PDMP (n = 158) to 10 months post-PDMP (n = 228). Interrupted time series analysis was performed to determine the effect of the PDMP on opioid prescribing. Results Over the 20-month study period, there was an overall decrease in the rate of opioid prescriptions per month (− 3.6% change, p < 0.001). On interrupted time series analysis, PDMP implementation was not associated with a significant decrease in the monthly rate of opioid prescriptions (1.27% change post-PDMP, p = 0.4). However, PDMP implementation was associated with a reduction in opioid prescriptions of greater than 5 days’ supply (− 2.7% per month, p = 0.03). Conclusion Opioid prescriptions declined in pediatric surgical patients over the study time period. State-wide PDMP implementation was associated with a reduction in postoperative opioid prescriptions of more than 5 days’ duration.

Assessment of Postoperative Opioid Prescriptions Before and After Implementation of a Mandatory Prescription Drug Monitoring Program

“…Previous studies in this field examined preimplementation data for only 10 months or less of prescribing. 18 , 20 , 22 , 26 Furthermore, 3 studies included only 1 surgical specialty, 18 , 20 , 23 and 1 study examined a pediatric population. 22 Strengths of our study compared with previous work include a large EHR-based data set from 24 hospitals and numerous surgical specialties during a period of 5 years.…”

“…Previous studies in this field examined preimplementation data for only 10 months or less of prescribing. 18,20,22,26 Furthermore, 3 studies included only 1 surgical specialty, 18,20,23 and 1 study examined a pediatric population. 22 The study also has limitations.…”

“…18,20,22,26 Furthermore, 3 studies included only 1 surgical specialty, 18,20,23 and 1 study examined a pediatric population. 22 The study also has limitations. First, the implementation of the CURES mandate did not occur in isolation of other efforts to limit postoperative opioid prescribing.…”

“…Although most studies examining the consequences of mandated PDMP consultation have reported an associated reduction in opioid prescribing, the data have been mixed. 18 , 19 , 20 , 21 , 22 , 23 Few studies have focused on postoperative prescribing despite the fact that 80% of patients receive an opioid analgesic medication for pain management after surgery. 24 , 25 Among studies that have examined postoperative prescribing, the focus has been on changes within 1 year, 26 within a single specialty, 18 , 20 , 23 or within pediatric populations.…”

“… 24 , 25 Among studies that have examined postoperative prescribing, the focus has been on changes within 1 year, 26 within a single specialty, 18 , 20 , 23 or within pediatric populations. 22 We examined 5 years of electronic health record (EHR) data from before and after the implementation of mandated CURES consultation prompted by an EHR-based alert. We investigated whether this mandatory PDMP consultation was associated with changes in the postoperative quantity of opioids prescribed at discharge after general, obstetric/gynecologic (obstetric/gynecologic), and orthopedic surgery among adult patients in a single health care system.…”