The Effect of Prescription Drug Monitoring Programs and Opioids Dispensed Following ED Visits

Opioid analgesics are often go-to prescriptions for treating acute pain both during and after an emergency department (ED) visit, especially for patients with sickle cell disease (SCD) or cancer with bone metastasis. However, while recent policies like mandated prescription drug monitoring programs (PDMPs) have been implemented with the goal of improving opioid prescribing, they may inadvertently limit access for such patients. This study, which included PISC postdoctoral fellow Austin Kilaru, MD and Executive Committee member Zachary F. Meisel, MD, MPH, MA, examined 2011-2017 Health Care Cost Institute (HCCI) claims data and found that comprehensive PDMP mandates were associated with substantial reductions in opioids dispensed to patients with SCD or cancer with bone metastasis during ED visits. Potential reasons for this include decreased prescribing due to clinician concerns about misuse, increased administrative burden, and prescriber perception of liability associated with opioid prescribing. Although the authors acknowledge that the study was limited by a lack of data on whether opioids were clinically indicated and whether prescriptions were written by ED or non-ED clinicians, they assert that future studies have potential to uncover more about the nuances of opioid prescribing policies and their effects on patients with serious acute pain.

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