Suboptimal Opioid Prescribing: A Practice Change Project

In the U.S. in 2015, the proportion of people dependent on opioids approached one percent, and opioid overdose rivaled auto accidents as the leading cause of accidental death. The literature suggests a credible link between increased opioid prescribing and increased opioid addiction. Accordingly, some have suggested that limiting the number of opioid prescriptions (and the number of doses per prescription) might be effective in reducing the number of opioid-related deaths. Toward this end, we designed and piloted an evidence-based quality-improvement project in four urgent care clinics. Results of the intervention were monitored with data from a state-sponsored prescription drug-monitoring program (PDMP) by comparing opioid prescribing before and after adoption of the guideline, and in this manner, a statistically significant (P < 0.05) decline in the rate of opioid prescribing was revealed. On average, 2.43 fewer opioid prescriptions were written, per provider, per week, in weeks five through eight after promulgation (5.21, SD =4.37) than in the eight weeks before promulgation (7.64, SD =7.73). Our results suggest that implementing a simple opioid-prescribing guideline, with monitoring, can reduce sub-optimal opioid prescribing, and therefore the volume of opioids available in the community for diversion, abuse, and addiction.