Opioid Prescribing Dips After State-Mandated ePrescribing Program

Physicians prescribed fewer opioids after the implementation of a state-mandated opioid ePrescribing program, according to a study published in The Journal of Hand Surgery Global Online.

Researchers evaluated physician prescribing patterns for four common outpatient hand surgeries: carpal tunnel release (CTR), ganglion excision, distal radius fracture (DRF) open reduction internal fixation (ORIF), and carpometacarpal (CMC) arthroplasty.

The study authors retrospectively reviewed patients who underwent one of the four surgeries and analyzed the number of tablets and morphine milligram equivalents (MMEs) physicians prescribed them before and after the policy implementation. The study included a total of 428 patients.

After implementation of the ePrescribing policy, there was a significant decrease in MMEs prescribed for ganglion excision (68 vs 50) and CMC arthroplasty (283 vs 217).

There was also a significant decrease in the total number of tablets prescribed for ganglion excision (11 vs 6.8), CMC arthroplasty (36 vs 29), and DRF ORIF (31 vs 28).

Additionally, the study authors found that the number of patients that received an opioid prescription following CTR (30 percent vs 51 percent) and ganglion excision (11 percent vs 53 percent) decreased after the opioid ePrescribing program began.

“These findings support the value of ePrescribing as a potential tool to further decrease excess opioid prescriptions,” the authors said.

A reason for the changes in opioid prescribing patterns could be that ePrescriptions may allow for better documentation of medications prescribed, which may lead to increased transparency regarding physician and patient accountability, the researchers suggested.

“Physician and patient accountability are essential components in combating opioid overuse, as prior studies have shown that educational interventions focused on raising awareness of opioid overprescribing in both physicians and patients can lead to a significant decrease in postoperative opioid prescriptions and consumption,” the study authors wrote.

Additionally, ePrescribing may facilitate prescription refill efficiency, which could limit excess pills initially prescribed in anticipation of persistent postoperative pain, they suggested.

However, the researchers noted that their study findings are limited as they are based on data from a single institution.

“These data may not reflect the prescribing pattern of hand surgeons in other locations or settings,” they wrote. “Similarly, one cannot generalize our findings to the prescribing patterns of physicians in private practice settings or in other surgical specialties.”

Additionally, while this study suggests that the implementation of ePrescribing reduced postoperative opioid prescriptions, other factors may have contributed to the changes in physician prescribing patterns. For instance, physicians may have grown more aware of the opioid epidemic or felt societal pressure to reduce opioid prescriptions, the authors suggested.

“Lastly, although our data demonstrate a significant decrease in the total number of opioid pills prescribed and MMEs following our ePrescribing policy implementation, the clinical implications, including the impact of this decline on the risk of opioid addiction or long-term use following hand surgery, remain unknown and are an area for further investigation,” the study authors said.

The researchers also noted that future studies should examine the impact of opioid ePrescribing in various states and practice settings to assess how these differences may affect the intervention’s success in reducing postoperative opioid prescriptions.

“Overall, such data would establish a foundation to support the utility of ePrescribing for states that are yet to adopt it and facilitate the establishment of standardized postoperative protocols for opioid prescriptions after common upper extremity procedures,” the researchers concluded.