Association of the "CDC Guideline for Prescribing Opioids for Chronic Pain" With Emergency Department Opioid Prescribing

Abstract

Background: The number of unintentional deaths due to prescription drug overdose has risen in recent years due to the increased utilization of opioid analgesics. Pain is one of the most common reasons for patients to visit an emergency department (ED) and is often treated with opioid analgesics. In 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for primary care providers on prescribing opioids for chronic pain.

Objectives: The objective of this study was to determine if release of the 2016 CDC guidelines for prescribing opioids for chronic pain was associated with changes in prescribing habits in the ED of an academic medical center.

Methods: The data were extracted from patient electronic health records between January 2015 and June 2017. The primary endpoint of the study was average morphine equivalent daily dose (MEDD) for the pre- and postguideline cohorts.

Results: A total of 8652 patients were included in the analysis (4389 in the preguideline cohort and 4263 in the postguideline cohort). The average MEDD decreased significantly from 30.6 ± 20.2 MEDD in the preguideline cohort to 29.8 ± 19.5 MEDD in the postguideline cohort (p = 0.0460). There was also a significant decrease in the rate of concomitant opioid and benzodiazepine prescribing as well as average days' supply per prescription in the postguideline cohort, as compared with the preguideline cohort.

Conclusions: The average MEDD prescribed in the ED of an academic medical center decreased after the release of the CDC guidelines on opioid prescribing for chronic pain.

Keywords: emergency department; guidelines; opioids; pain; prescribing.