Opioid prescribing guidelines in hospital emergency departments can reduce the rates of opioid prescriptions for minor conditions and chronic noncancer pain, according to new findings at Temple University Hospital (TUH) and Temple University Hospital-Episcopal Campus (TUH-Episcopal).
Emergency physicians are often the targets of patients seeking opioids for nonmedical purposes. Research also has shown that acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain.
Given the difficulty in finding a balance between providing appropriate pain relief for patients and making sure there is no formation or exacerbation of drug dependence, the U.S. Department of Health and Human Services has recommended the synthesis of pain management guidelines and the creation of clinical decision support tools.
TUH and TUH-Episcopal were among those that created a guideline for prescribing opioids in order to maximize safety and avoid misuse.
“The impact of this type of guideline had never been studied in an acute care setting,” says Daniel del Portal, M.D., FAAEM, Assistant Professor of Clinical Emergency Medicine at the Lewis Katz School of Medicine at Temple University, Assistant Director of Clinical Operations at TUH and Jeanes Hospital, and principal investigator of the study.
“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.”
The researchers compared the rate of opioid prescriptions for dental, neck/back and chronic noncancer pain before and after adoption of the guideline in January 2013. The team looked at data from 13,187 patients aged 18 years or older who met the diagnosis criteria and were discharged from the emergency departments at TUH and TUH-Episcopal.
The researchers also gave a survey to the faculty emergency medicine physicians who were practicing in the two emergency departments.
The findings reveal that the prescribing guideline had an immediate and sustained impact in reducing opioid prescribing rates for all age groups and for each of the three categories of complaints with a high degree of statistical significance.
Furthermore, 100 percent of physicians surveyed supported implementation of the voluntary guideline. Most (97 percent) felt the guideline had facilitated discussions with patients when opioids were being withheld, and nearly 75 percent of respondents reported encountering less hostility from patients once the guidelines were in place.
“Emergency physicians and other acute care providers can use various tools to promote the rational prescribing of dangerous opioid medications,” says del Portal.
“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.”
The U.S. is currently in an opioid addiction crisis with deaths from opioid prescription overdose exceeding those from heroin and cocaine combined.
The findings are published in the Journal of Emergency Medicine.
Source: Temple University Health System