Opioid e-prescribing trends at discharge in a large pediatric health system

Abstract

Objective: Legitimate opioid prescriptions have been identified as a risk factor for opioid misuse in pediatric patients. In 2014, Pennsylvania legislation expanded a prescription drug monitoring program (PDMP) to curb inappropriate controlled substance prescriptions. The authors’ objective was to describe recent opioid prescribing trends at a large, pediatric health system situated in a region with one of the highest opioid-related death rates in the United States and examine the impact of the PDMP on prescribing trends.Design: Quasi-experimental assessment of trends of opioid e-prescriptions, from 2012 to 2017. Multivariable Poisson segmented regression examined the effect of the PDMP. Period prevalence comparison of opioid e-prescriptions across the care continuum in 2016.Results: There were 62,661 opioid e-prescriptions identified during the study period. Combination opioid/non-opioid prescriptions decreased, while oxycodone prescriptions increased. Seasonal variation was evident. Of 110,884 inpatient encounters, multivariable regression demonstrated lower odds of an opioid being prescribed at discharge per month of the study period (p 0.001) and a significant interaction between passage of the PDMP legislation and time (p = 0.03). Black patients had lower odds of receiving an opioid at discharge compared to white patients. Inpatients had significantly greater odds of receiving an opioid compared to emergency department (Prevalence Odds Ratio 7.1 [95% confidence interval: 6.9-7.3]; p 0.001) and outpatient (398.9 [355.5-447.5]; p 0.001) encounters.Conclusion: In a large pediatric health system, oxycodone has emerged as the most commonly prescribed opioid in recent years. Early evidence indicates that a state-run drug monitoring program is associated with reduced opioid prescribing. Additional study is necessary to examine the relationship between opioid prescriptions and race.

Evaluating a health system‐wide opioid disposal intervention distributing home‐disposal bags

“…Prior studies have found seasonal trends in opioid prescriptions and prescription opioid-related overdoses and suicides. [53][54][55] Our study has several limitations. First, we relied on participants to report their disposal behaviors and accurately self-report their T A B L E 3 Univariable and multivariable modified Poisson regression analyses examining prescription opioid disposal among survey respondents with leftover prescription opioids that were filled at a health system pharmacy.…”

Opioid Analgesia Compared with Non-Opioid Analgesia After Operative Treatment for Pediatric Supracondylar Humeral Fractures

“…At the policy level, practices such as prescription drug monitoring programs, state-mandated preoperative opioid informed consent, and electronic prescribing are increasingly widespread 23 . Some reports in the literature have indicated positive effects of these programs in decreasing rates of opioid prescriptions overall 24,25 and specifically in pediatric orthopaedics 26,27 , reducing overdoses 28 , and decreasing prescriptions for unnecessarily high doses 29 . However, others have reported mixed results and poor implementation [30][31][32][33] .…”

Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter?

“…Providers may have implicit biases that minorities are more likely to abuse narcotics, 51 which may influence providers to be less likely to prescribe narcotics for minorities. 15,52 Several studies have demonstrated that Black and Hispanic patients are less likely to receive opioid medications than White patients. [10][11][12][13][14][15][16][17] These trends are also seen in opioid prescriptions for children, including pediatric emergency department visits, 16 pediatric inpatient admissions, 13 pediatric hospital discharge e-prescriptions, 15 pediatric patients with long bone fractures, 17 and in the general outpatient ambulatory setting.…”

“…15,52 Several studies have demonstrated that Black and Hispanic patients are less likely to receive opioid medications than White patients. [10][11][12][13][14][15][16][17] These trends are also seen in opioid prescriptions for children, including pediatric emergency department visits, 16 pediatric inpatient admissions, 13 pediatric hospital discharge e-prescriptions, 15 pediatric patients with long bone fractures, 17 and in the general outpatient ambulatory setting. 14 Creating standardized postoperative patient care pathways will hopefully help alleviate racial bias in opioid administration and prescribing.…”

“…Several studies have demonstrated that Black and Hispanic patients are less likely to receive opioid medications than White patients. [10][11][12][13][14][15][16][17] These trends are also seen in opioid prescriptions for children across various specialties and clinical settings, [13][14][15][16][17] but it is unknown how these biases or trends might affect opioid prescription practices in infants undergoing cleft lip repair.…”