J. L. Philip1, J. R. Imbus1, J. S. Danobetia1, N. Zaborek1, D. F. Schneider1, D. M. Melnick1 1University Of Wisconsin,Madison, WI, USA
Introduction:
The opioid epidemic continues. Overprescribing of opioids contributes to excess opioid supply for diversion and abuse. Recent data demonstrates wide variation in prescribing and significant over-prescribing following outpatient general surgery procedures. Many states have implemented prescription drug monitoring programs (PDMP) as a tool to help prevent and monitor prescription drug misuse and abuse. Beginning on April 1, 2017 Wisconsin law requires prescribers to review the WI electronic PDMP (ePDMP) prior to issuing most controlled substance prescriptions to their patients. Our aim was to investigate trends in opioid prescription amounts and to evaluate the impact of the ePDMP requirement on surgeon prescribing practices.
Methods:
We collected prescription data retrospectively for three months before and after implementation of the law, as well as for two months one year prior. Eligible procedures included outpatient inguinal hernia repair, umbilical hernia repair, laparoscopic cholecystectomy, and breast lumpectomy +/- sentinel lymph node biopsy. All opioid prescriptions were converted to standard morphine milligram equivalents (MME). We compared mean MMEs prescribed for different time periods. To estimate the effect of mandatory ePDMP review in Wisconsin on weekly mean MMEs prescribed, we performed an interrupted time-series analysis using an autoregressive integrated moving average (ARIMA) model with weekly intervals.
Results:
In January-March of 2017, the mean MME prescribed following outpatient operations was 135 ± 4.0 (~27 5mg hydrocodone pills). The amount in January 2016 was significantly higher (216 ± 10.2, ~43 5mg hydrocodone pills, p<0.001). There was a significant decrease in the mean MME prescribed in the three months following the implementation of the ePDMP requirement (114 ± 3.6 MME, ~23 5mg hydrocodone pills, p<0.001 vs. January-March 2017 & vs. January 2016). There was no difference in the procedure make-up across time periods. Figure 1 demonstrates a downward trend of opioids prescribed over time. Time-series analysis did not reveal a significant intervention effect (intervention parameter -1.84, t-value = -0.99, p = 0.335) for the implementation of the mandatory ePDMP review.
Conclusion:
We demonstrate a decrease in the amount of opioids prescribed by general surgeons for outpatient operations from January to June 2017 and a significant decrease compared to 2016. The implementation of mandatory ePDMP requirements for opioid prescribers does not appear to have had an effect on the amount of opioid prescribed in the early post-intervention period suggesting that additional factors have contributed to decreased prescription amounts.
