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October 20, 2019
10/20/2019 10:15:00 AM - 10/20/2019 12:15:00 PM
Room WA2 - Area C
Impact of a Statewide Opioid Mandate on the Volume of Inpatient Opioid Prescriptions: A Single Institution Study
Louis Lu, M.D., Nikhil A. Crain, B.S., Kristina Borja, B.S., Quang T. Nguyen, B.S., Joseph B. Rinehart, M.D., Shalini Shah, M.D.
University of California, Irvine, Orange, California , United States
Disclosures: L. Lu: None.N.A. Crain: None.K. Borja: None.Q.T. Nguyen: None.J.B. Rinehart: None. S. Shah: Funded Research; Self; Pfizer.
Introduction: From 1999 to 2014 prescription opioid sales have quadrupled while there has been mounting evidence that opioid use leads to increased morbidity and mortality. Given the nationwide over prescription of opioids, there have been efforts to curtail physician prescribing patterns including policymaking, education initiatives, and prescription drug monitoring programs (PDPMs). On October 1, 2018, California’s PDPM, the Controlled Substance Utilization Review and Evaluation System (CURES), mandated that all providers review patient opioid records in their database before prescription up to a 30-day supply of narcotics. If providers did not look up patients in the CURES database, they could only prescribe up to a 5 day supply upon discharge. Given the recent CURES mandate, there is a paucity of data on the effectiveness of legislation to alter the culture of prescribing opioids in an inpatient hospital setting. We hypothesized that the statewide opioid prescribing mandate would decrease the amount of inpatient opioid prescriptions provided upon discharge.

Methods: This is a single center retrospective observational IRB-approved study of inpatient opioid prescriptions provided between November 2017 and March 2018. The primary outcome was the amount of morphine equivalents per outpatient opioid prescription over this time period separated into two groups: pre and post October 1, 2018 CURES mandate. Prescriptions provided to patients between September 1, 2018 and October 31, 2018 were excluded to account for a month long transition period before and after the mandate. Prescriptions for patients < 18 years old and those seen and discharged from the emergency department were excluded. Univariate differences were assessed via t-tests and chi-square tests. Multivariate linear regression accounted for the specialty of prescribing physician.

Results: A total of 13,874 inpatient opioid prescriptions were provided between November 2017 and March 2018 excluding September and October 2018 of which 10,126 were prescribed before the CURES mandate and 3,748 were provided afterwards. For the pre-mandate group, 53.5% were women vs 53.0% of the post-mandate group (p = 0.60), the mean age was 51.6 (95% CI 51.3-51.9) vs 51.9 (95% CI 51.4-52.5, p = 0.33) and 30.9% were hispanic vs 30.1% (p = 0.37). 64.5% of prescriptions for the pre-mandate group contained hydrocodone vs 59.4% for the post-mandate group, 34.3% contained oxycodone for the pre group vs 39.1% for the post group, and 1.2% contained hydromorphone vs 1.4% (p < 0.001). In terms of specialities prescribing opioids, the most common were general surgery (25.7%), orthopedics (8.3%), internal medicine (8.3%), oncology (6.4%), obstetrics (4.8%), and neurology (3.4%). For the pre-mandate group, the average morphine equivalents per opioid prescription was 209.2 (95% CI 202.8-215.7) vs 163.5 (95% CI 156.7-170.2, p < 0.0001) for the post-mandate group. Upon multivariate analysis accounting for specialty of prescribing physician, the difference between morphine equivalents for the pre and post group was still statistically significant (p = 0.04).

Conclusion: The amount of morphine equivalents provided per inpatient opioid prescription upon discharge was statistically significantly lower after the implementation of the CURES mandate in October 2018 suggesting that state-wide regulation, which was accompanied by a plethora of hospital initiatives notifying providers of its implementation, does have an effect on inpatient opioid prescribing patterns. Of note, there was a 5% decrease in the number of hydrocodone prescriptions with an accompanying 5% increase in oxycodone prescriptions with surgeons the most likely physicians to provide outpatient opioid prescriptions. Our study strongly suggests that statewide legislation with adequate hospital implementation is a potentially successful strategy in decreasing the prescription of opioids.

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