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Open Access Publications from the University of California

Effect Of A “No Superuser Opioid Prescription” Policy On ED Visits And Statewide Opioid Prescription


Introduction: The U.S. opioid epidemic has highlighted the need to identify patients at riskof opioid abuse and overdose. We initiated a novel emergency department- (ED) basedinterventional protocol to transition our superuser patients from the ED to an outpatient chronicpain program. The objective was to evaluate the protocol’s effect on superusers’ annual ED visits.Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for thesepatients, unique prescribers of controlled substances, and ancillary testing.

Methods: Patients were referred to the program with the following inclusion criteria: ≥ 6 visitsper year to the ED; at least one visit identified by the attendi ng physician as primarily driven byopioid-seeking behavior; and a review by a committee comprising ED administration and casemanagement. Patients were referred to a pain management clinic and informed that they wouldno longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronicmedical record (EMR) alerts notified ED providers of the patient’s referral at subsequent visits. Weanalyzed one year of data pre- and post-referral.

Results: A total of 243 patients had one year of data post-referral for analysis. Median annualED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]). We also found statisticallysignificant decreases for these patients’ state prescription drug monitoring program (PDMP) opioidprescriptions (21 to 13), total unique controlled-substance prescribers (11 to 7), computed tomographyimaging (2 to 0), radiographs (5 to 1), electrocardiograms (12 to 4), and labs run (47 to 13).

Conclusion: This program and the EMR-based alerts were successful at decreasing local EDvisits, annual opioid prescriptions, and hospital resource allocation for this population of patients.There is no evidence that these patients diverted their visits to neighboring EDs after beinginformed that they would not receive opioids at this hospital, as opioid prescriptions obtained bythese patients decreased on a statewide level. This implies that individual ED protocols can havesignificant impact on the behavior of patients. [West J Emerg Med. 2017;18(5)894-902.]

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