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  • Benefits of Standardized Opioid Prescribing Guidance

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, November 2020

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    Although an ophthalmologist gener­ally writes fewer than a dozen opioid prescriptions each year, cumulative reduction could help limit the abuse and diversion of unused narcotics that may result from overprescribing. In a study of opioid prescribing patterns at an academic ophthal­mology department, Starr et al. looked at the effect of implementing standard pre­scribing guidelines for acute postoperative pain. They found that the new guide­lines led to reductions in both quantity and frequency of opioid prescriptions.

    For their study, the authors searched electronic health records (EHRs) of patients with no history of long-term opioid use and with no opioids prescribed from 90 to seven days before surgery. All prescrip­tions for an opioid agonist, opioid partial agonist, or opioid combination were counted. The quantity of opioids prescribed for post-op use was con­verted to oral morphine equivalents (OME, in milligrams), and three target prescribing categories were defined based on the type of surgery (i.e., level 0 = no OME; level 1 = ≤40 OME; level 2 = ≤80 OME). Assessments of the existing opioid prescribing practices were made during a six-month period. After this point, standardized prescrib­ing guidelines and information on pain management and alternatives were disseminated throughout the depart­ment. In addition, electronic flags were built into the EHR system. Prescribing patterns during the subsequent six months were reviewed.

    More than 5,300 surgeries are rep­resented in this study (2,613 in the first period, 2,736 in the latter period). After implementing the guidelines, 3.0% of patients received opioid prescriptions compared with 4.4% previously (p < .005). The mean OME was significantly lower overall (42 vs. 93 mg; p < .001) and for level 0 and 1 procedures. Of the surgeries in the first six months, 96% would not have exceeded the maximum recommendation (≤80 OME); this increased to 99% once the guidelines were in place. The number of refills did not increase.

    The authors recommend a review of prescribing practices and consider­ation of guidelines that would reduce overprescribing yet effectively man­age patients’ pain after surgery. They emphasized that ongoing education of prescribers will be crucial to improve adherence to any new guidelines.

    The original article can be found here.