A statewide prescription monitoring program affects emergency department prescribing behaviors.

STUDY OBJECTIVE Ohio recently instituted an online prescription monitoring program, the Ohio Automated Rx Reporting System (OARRS), to monitor controlled substance prescriptions within Ohio. This study is undertaken to identify the influence of OARRS data on clinical management of emergency department (ED) patients with painful conditions. METHODS This prospective quasiexperimental study was conducted at the University of Toledo Medical Center Emergency Department during June to July 2008. Eligible participants included ED patients with painful conditions. Patients with acute injuries were excluded. After clinical evaluation, and again after presentation of OARRS data, providers answered a set of questions about anticipated pain prescription for the patient. Outcome measures included changes in opioid prescription and other potential factors that influenced opioid prescription. RESULTS Among 179 participants, OARRS data revealed high numbers of narcotics prescriptions filled in the most recent 12 months (median 7; range 0 to 128). Numerous providers prescribed narcotics for patients (median 3 per patient; range 0 to 40). Patients had filled narcotics prescriptions at different pharmacies (mean [SD] 3.5 [4.4]). Eighteen providers are represented in the study. Four providers treated 63% (N=114) of the patients in the study. After review of the OARRS data, providers changed the clinical management in 41% (N=74) of cases. In cases of altered management, the majority (61%; N=45) resulted in fewer or no opioid medications prescribed than originally planned, whereas 39% (N=29) resulted in more opioid medication than previously planned. CONCLUSION The use of data from a statewide narcotic registry frequently altered prescribing behavior for management of ED patients with complaints of nontraumatic pain.

[1]  J. Wilson,et al.  Oligoanalgesia in the emergency department. , 1989, The American journal of emergency medicine.

[2]  Laxmaiah Manchikanti,et al.  National drug control policy and prescription drug abuse: facts and fallacies. , 2007, Pain physician.

[3]  W. B. Millard.  Grounding frequent flyers, not abandoning them: drug seekers in the ED. , 2007, Annals of emergency medicine.

[4]  Grant M. Carrow,et al.  Pain management and prescription monitoring. , 2002, Journal of pain and symptom management.

[5]  Sandra E. Ward,et al.  Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain , 1995 .

[6]  K. Foley,et al.  College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement. , 2003, Drug and alcohol dependence.

[7]  J. Ducharme,et al.  Documented use of analgesics in the emergency department and upon release of patients with extremity fractures. , 1997, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[8]  L. White,et al.  Prehospital use of analgesia for suspected extremity fractures. , 2000, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[9]  C. Woolf,et al.  Use and abuse of opioid analgesics: potential methods to prevent and deter non-medical consumption of prescription opioids. , 2004, Current opinion in investigational drugs.

[10]  L. Manchikanti,et al.  Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables. , 2006, Pain physician.

[11]  Thomas R. Frieden,et al.  Overdose deaths involving prescription opioids among Medicaid enrollees - Washington, 2004-2007. , 2009, MMWR. Morbidity and mortality weekly report.

[12]  Leonard J Paulozzi,et al.  Patterns of abuse among unintentional pharmaceutical overdose fatalities. , 2008, JAMA.

[13]  L. McCaig,et al.  Trends in hospital emergency department utilization: United States, 1992-99. , 2001, Vital and health statistics. Series 13, Data from the National Health Survey.

[14]  L. Manchikanti.  Prescription drug abuse: what is being done to address this new drug epidemic? Testimony before the Subcommittee on Criminal Justice, Drug Policy and Human Resources. , 2006, Pain physician.

[15]  D. M. Phillips.  JCAHO Pain Management Standards Are Unveiled , 2000 .

[16]  Nora D Volkow,et al.  Major increases in opioid analgesic abuse in the United States: concerns and strategies. , 2006, Drug and alcohol dependence.

[17]  J. L. Dahl,et al.  A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997-2002. , 2004, Journal of pain and symptom management.

[18]  P. Cummings,et al.  Emergency department analgesia for fracture pain. , 2003, Annals of emergency medicine.

[19]  F. Blank,et al.  Adequacy of pain assessment and pain relief and correlation of patient satisfaction in 68 ED fast-track patients. , 2001, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[20]  P. Christo,et al.  The influence of prescription monitoring programs on chronic pain management. , 2009, Pain physician.

[21]  L. White,et al.  P REHOSPITAL U SE OF A NALGESIA FOR S USPECTED E XTREMITY F RACTURES , 2000 .

[22]  S. Atluri,et al.  Development of a screening tool to detect the risk of inappropriate prescription opioid use in patients with chronic pain. , 2004, Pain physician.

[23]  V. Guru,et al.  The patient vs. caregiver perception of acute pain in the emergency department. , 2000, The Journal of emergency medicine.

[24]  L. Manchikanti,et al.  Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients. , 2007, Journal of opioid management.

[25]  K. Schulman,et al.  Geographic Variation in the Prescription of Schedule II Opioid Analgesics among Outpatients in the United States , 2006 .

[27]  K. Delaney,et al.  Inadequate analgesia in emergency medicine. , 2004, Annals of emergency medicine.

[28]  S. Martins,et al.  Correlates of extramedical use of OxyContin versus other analgesic opioids among the US general population. , 2009, Drug and alcohol dependence.

[29]  Burt Cw,et al.  Trends in hospital emergency department utilization: United States, 1992-99. , 2001 .