Reduction of Parenteral Opioid Use in Community Emergency Departments Following Implementation of Treatment Guidelines

Abstract

Objective

Opioid prescribing guidelines are commonly seen as part of the solution to America's opioid epidemic. However, the effectiveness of specific treatment guidelines on altering opioid prescribing in the Emergency Department (ED) is unclear. We examined provider ordering patterns before and after implementation of opioid use guidelines for ED patients overall and the specific subsets of ED patients with either chronic opioid use or fracture.

Methods

We conducted a pre-post interrupted time series analysis of adult (≥18 years old) ED encounters in 14 integrated community EDs before (2013) and after (2014) the implementation of opioid prescribing guidelines. We compared opioid use pre- and post-intervention using segmented logistic regression for primary and secondary analyses. The primary outcome was parenteral opioid use in the ED, with additional subgroup analysis of chronic pain and fracture cohorts. We also examined ED oral opioid use and discharge prescribing.

Results

There were 508,337 pre- and 531,620 post-intervention encounters. The intervention was associated with an initial reduction in the odds of parenteral opioids ordered (OR=0.89, 95% CI 0.87-0.91) and a decrease in the monthly trend compared to the pre-intervention period (OR=0.99, 95% CI 0.99-0.99). The immediate reduction in parenteral opioid use was significantly larger in the cohort of patients with chronic pain (OR=0.81, 95% CI 0.72-0.91), whereas the fracture cohort showed no change (OR=1.10, 95% CI 0.97-1.25).

Conclusion

The use of an opioid ordering guideline was associated with significant reduction in parenteral opioid use in the ED, and as intended subgroup comparisons suggest acute fractures were not affected and chronic pain visits were associated with larger decreases in opioid use.

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