Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates
Background Prescription drug monitoring programs (PDMPs) exist in 49 states to guide opioid prescribing. In 40 states, clinicians must check the PDMP prior to prescribing an opioid. Data on mandated PDMP checks show mixed results on opioid prescribing. Objectives This study sought to examine the imp...
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| Veröffentlicht in: | Journal of medical toxicology 2021-07, Vol.17 (3), p.265-270 |
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| container_title | Journal of medical toxicology |
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| creator | Watson, C. James Ganetsky, Michael Burke, Ryan C. Dizitzer, Yotam Leventhal, Evan L. Boyle, Katherine L. |
| description | Background
Prescription drug monitoring programs (PDMPs) exist in 49 states to guide opioid prescribing. In 40 states, clinicians must check the PDMP prior to prescribing an opioid. Data on mandated PDMP checks show mixed results on opioid prescribing.
Objectives
This study sought to examine the impact of the Massachusetts mandatory PDMP check on opioid prescribing for discharges from an urban tertiary emergency department (ED).
Methods
This was a retrospective cohort study of discharges from one ED from 7/1/2010–10/15/2018. The primary outcome was the monthly percentage of patients discharged from the ED with an opioid prescription. The intervention was Massachusetts mandating a PDMP check for all opioid prescriptions. Prescribing was compared pre- and post-mandate. Interrupted time series (ITS) analysis accounted for known declining trends in opioid prescribing.
Results
Of 273,512 ED discharges, 35,050 (12.8%) received opioid prescriptions. Mean monthly opioid prescribing decreased post-intervention from 15.1% (SD ± 3.5%) to 5.1% (SD ± 0.9%;
p
< 0.001). ITS showed equal pre and post-intervention slopes (−0.002,
p
= 0.819). A small immediate decrease occurred in prescribing around the mandated check: a 3-month level effect decrease of 0.018 (
p
= 0.039), 6-month level effect 0.019 (
p
= 0.023), and a 12-month level effect of 0.020 (
p
= 0.019). The 24-month level effect was not decreased.
Conclusion
Prior to the mandated PDMP check, ED opioid prescribing was declining. The mandate did not change the rate of decline but was associated with a non-sustained drop in opioid prescribing immediately following enactment. |
| doi_str_mv | 10.1007/s13181-021-00837-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8206309</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2541123417</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-eba1097bcec2d9132c457c60a111c9f690fa43d570802c451bd10d6d50ab92693</originalsourceid><addsrcrecordid>eNp9UctO3DAUtaqiQof-QBfIUteh99rOw5tK1QylSCBQVdaW4zjBQOJgZ5Dm7-swDIUNC8vXOo975EPIV4RjBCi_R-RYYQYsHah4mYkP5ABlGgop849pzvMik8DlPvkc4y1AejPxiexzXjEUXByQh7N-1GaivqWaXuih0ZMPG3oVbDTBjZPzA12FdUcv_OAS5IYugb4LuqfLG2vuaCKc9DZ0djAburKjDlNvh4lejs67ZudUz8I_erLxkOy1-j7aL8_3glz_Ovm7_J2dX56eLX-eZ0aUYspsrRFkWRtrWCORMyPy0hSgEdHItpDQasGbvIQKZgzrBqEpmhx0LVkh-YL82PqO67q3jUmZgr5XY3C9DhvltVNvkcHdqM4_qopBwWE2-PZsEPzD2sZJ3fp1GFJmxXKByLjAMrHYlmWCjzHY9mUDgpprUtuaVKpJPdWkRBIdvc72Itn1kgh8S4jj_OU2_N_9ju0_FR6fZg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2541123417</pqid></control><display><type>article</type><title>Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates</title><source>SpringerLink Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Watson, C. James ; Ganetsky, Michael ; Burke, Ryan C. ; Dizitzer, Yotam ; Leventhal, Evan L. ; Boyle, Katherine L.</creator><creatorcontrib>Watson, C. James ; Ganetsky, Michael ; Burke, Ryan C. ; Dizitzer, Yotam ; Leventhal, Evan L. ; Boyle, Katherine L.</creatorcontrib><description>Background
Prescription drug monitoring programs (PDMPs) exist in 49 states to guide opioid prescribing. In 40 states, clinicians must check the PDMP prior to prescribing an opioid. Data on mandated PDMP checks show mixed results on opioid prescribing.
Objectives
This study sought to examine the impact of the Massachusetts mandatory PDMP check on opioid prescribing for discharges from an urban tertiary emergency department (ED).
Methods
This was a retrospective cohort study of discharges from one ED from 7/1/2010–10/15/2018. The primary outcome was the monthly percentage of patients discharged from the ED with an opioid prescription. The intervention was Massachusetts mandating a PDMP check for all opioid prescriptions. Prescribing was compared pre- and post-mandate. Interrupted time series (ITS) analysis accounted for known declining trends in opioid prescribing.
Results
Of 273,512 ED discharges, 35,050 (12.8%) received opioid prescriptions. Mean monthly opioid prescribing decreased post-intervention from 15.1% (SD ± 3.5%) to 5.1% (SD ± 0.9%;
p
< 0.001). ITS showed equal pre and post-intervention slopes (−0.002,
p
= 0.819). A small immediate decrease occurred in prescribing around the mandated check: a 3-month level effect decrease of 0.018 (
p
= 0.039), 6-month level effect 0.019 (
p
= 0.023), and a 12-month level effect of 0.020 (
p
= 0.019). The 24-month level effect was not decreased.
Conclusion
Prior to the mandated PDMP check, ED opioid prescribing was declining. The mandate did not change the rate of decline but was associated with a non-sustained drop in opioid prescribing immediately following enactment.</description><identifier>ISSN: 1556-9039</identifier><identifier>EISSN: 1937-6995</identifier><identifier>DOI: 10.1007/s13181-021-00837-4</identifier><identifier>PMID: 33821434</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Biomedical and Life Sciences ; Biomedicine ; Emergency medical care ; Emergency medical services ; Monitoring ; Narcotics ; Opioids ; Original ; Original Article ; Pharmacology/Toxicology ; Therapeutic drug monitoring</subject><ispartof>Journal of medical toxicology, 2021-07, Vol.17 (3), p.265-270</ispartof><rights>American College of Medical Toxicology 2021</rights><rights>American College of Medical Toxicology 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-eba1097bcec2d9132c457c60a111c9f690fa43d570802c451bd10d6d50ab92693</citedby><cites>FETCH-LOGICAL-c474t-eba1097bcec2d9132c457c60a111c9f690fa43d570802c451bd10d6d50ab92693</cites><orcidid>0000-0002-1003-5798</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206309/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206309/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,41467,42536,51297,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33821434$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Watson, C. James</creatorcontrib><creatorcontrib>Ganetsky, Michael</creatorcontrib><creatorcontrib>Burke, Ryan C.</creatorcontrib><creatorcontrib>Dizitzer, Yotam</creatorcontrib><creatorcontrib>Leventhal, Evan L.</creatorcontrib><creatorcontrib>Boyle, Katherine L.</creatorcontrib><title>Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates</title><title>Journal of medical toxicology</title><addtitle>J. Med. Toxicol</addtitle><addtitle>J Med Toxicol</addtitle><description>Background
Prescription drug monitoring programs (PDMPs) exist in 49 states to guide opioid prescribing. In 40 states, clinicians must check the PDMP prior to prescribing an opioid. Data on mandated PDMP checks show mixed results on opioid prescribing.
Objectives
This study sought to examine the impact of the Massachusetts mandatory PDMP check on opioid prescribing for discharges from an urban tertiary emergency department (ED).
Methods
This was a retrospective cohort study of discharges from one ED from 7/1/2010–10/15/2018. The primary outcome was the monthly percentage of patients discharged from the ED with an opioid prescription. The intervention was Massachusetts mandating a PDMP check for all opioid prescriptions. Prescribing was compared pre- and post-mandate. Interrupted time series (ITS) analysis accounted for known declining trends in opioid prescribing.
Results
Of 273,512 ED discharges, 35,050 (12.8%) received opioid prescriptions. Mean monthly opioid prescribing decreased post-intervention from 15.1% (SD ± 3.5%) to 5.1% (SD ± 0.9%;
p
< 0.001). ITS showed equal pre and post-intervention slopes (−0.002,
p
= 0.819). A small immediate decrease occurred in prescribing around the mandated check: a 3-month level effect decrease of 0.018 (
p
= 0.039), 6-month level effect 0.019 (
p
= 0.023), and a 12-month level effect of 0.020 (
p
= 0.019). The 24-month level effect was not decreased.
Conclusion
Prior to the mandated PDMP check, ED opioid prescribing was declining. The mandate did not change the rate of decline but was associated with a non-sustained drop in opioid prescribing immediately following enactment.</description><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Monitoring</subject><subject>Narcotics</subject><subject>Opioids</subject><subject>Original</subject><subject>Original Article</subject><subject>Pharmacology/Toxicology</subject><subject>Therapeutic drug monitoring</subject><issn>1556-9039</issn><issn>1937-6995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9UctO3DAUtaqiQof-QBfIUteh99rOw5tK1QylSCBQVdaW4zjBQOJgZ5Dm7-swDIUNC8vXOo975EPIV4RjBCi_R-RYYQYsHah4mYkP5ABlGgop849pzvMik8DlPvkc4y1AejPxiexzXjEUXByQh7N-1GaivqWaXuih0ZMPG3oVbDTBjZPzA12FdUcv_OAS5IYugb4LuqfLG2vuaCKc9DZ0djAburKjDlNvh4lejs67ZudUz8I_erLxkOy1-j7aL8_3glz_Ovm7_J2dX56eLX-eZ0aUYspsrRFkWRtrWCORMyPy0hSgEdHItpDQasGbvIQKZgzrBqEpmhx0LVkh-YL82PqO67q3jUmZgr5XY3C9DhvltVNvkcHdqM4_qopBwWE2-PZsEPzD2sZJ3fp1GFJmxXKByLjAMrHYlmWCjzHY9mUDgpprUtuaVKpJPdWkRBIdvc72Itn1kgh8S4jj_OU2_N_9ju0_FR6fZg</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Watson, C. James</creator><creator>Ganetsky, Michael</creator><creator>Burke, Ryan C.</creator><creator>Dizitzer, Yotam</creator><creator>Leventhal, Evan L.</creator><creator>Boyle, Katherine L.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1003-5798</orcidid></search><sort><creationdate>20210701</creationdate><title>Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates</title><author>Watson, C. James ; Ganetsky, Michael ; Burke, Ryan C. ; Dizitzer, Yotam ; Leventhal, Evan L. ; Boyle, Katherine L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-eba1097bcec2d9132c457c60a111c9f690fa43d570802c451bd10d6d50ab92693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Monitoring</topic><topic>Narcotics</topic><topic>Opioids</topic><topic>Original</topic><topic>Original Article</topic><topic>Pharmacology/Toxicology</topic><topic>Therapeutic drug monitoring</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Watson, C. James</creatorcontrib><creatorcontrib>Ganetsky, Michael</creatorcontrib><creatorcontrib>Burke, Ryan C.</creatorcontrib><creatorcontrib>Dizitzer, Yotam</creatorcontrib><creatorcontrib>Leventhal, Evan L.</creatorcontrib><creatorcontrib>Boyle, Katherine L.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of medical toxicology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Watson, C. James</au><au>Ganetsky, Michael</au><au>Burke, Ryan C.</au><au>Dizitzer, Yotam</au><au>Leventhal, Evan L.</au><au>Boyle, Katherine L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates</atitle><jtitle>Journal of medical toxicology</jtitle><stitle>J. Med. Toxicol</stitle><addtitle>J Med Toxicol</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>17</volume><issue>3</issue><spage>265</spage><epage>270</epage><pages>265-270</pages><issn>1556-9039</issn><eissn>1937-6995</eissn><abstract>Background
Prescription drug monitoring programs (PDMPs) exist in 49 states to guide opioid prescribing. In 40 states, clinicians must check the PDMP prior to prescribing an opioid. Data on mandated PDMP checks show mixed results on opioid prescribing.
Objectives
This study sought to examine the impact of the Massachusetts mandatory PDMP check on opioid prescribing for discharges from an urban tertiary emergency department (ED).
Methods
This was a retrospective cohort study of discharges from one ED from 7/1/2010–10/15/2018. The primary outcome was the monthly percentage of patients discharged from the ED with an opioid prescription. The intervention was Massachusetts mandating a PDMP check for all opioid prescriptions. Prescribing was compared pre- and post-mandate. Interrupted time series (ITS) analysis accounted for known declining trends in opioid prescribing.
Results
Of 273,512 ED discharges, 35,050 (12.8%) received opioid prescriptions. Mean monthly opioid prescribing decreased post-intervention from 15.1% (SD ± 3.5%) to 5.1% (SD ± 0.9%;
p
< 0.001). ITS showed equal pre and post-intervention slopes (−0.002,
p
= 0.819). A small immediate decrease occurred in prescribing around the mandated check: a 3-month level effect decrease of 0.018 (
p
= 0.039), 6-month level effect 0.019 (
p
= 0.023), and a 12-month level effect of 0.020 (
p
= 0.019). The 24-month level effect was not decreased.
Conclusion
Prior to the mandated PDMP check, ED opioid prescribing was declining. The mandate did not change the rate of decline but was associated with a non-sustained drop in opioid prescribing immediately following enactment.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>33821434</pmid><doi>10.1007/s13181-021-00837-4</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-1003-5798</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of medical toxicology, 2021-07, Vol.17 (3), p.265-270 |
| issn | 1556-9039 1937-6995 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8206309 |
| source | SpringerLink Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Biomedical and Life Sciences Biomedicine Emergency medical care Emergency medical services Monitoring Narcotics Opioids Original Original Article Pharmacology/Toxicology Therapeutic drug monitoring |
| title | Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates |
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