EHR, pharmacy alerts reduce opioid prescribing
In 2021, opioid overdoses hit a record high, highlighting the need for urgency in developing interventions. While already rising, the COVID-19 pandemic and its aftermath have led to the number of deaths rising exponentially, and 2023 has already set a new record for deaths going into the holidays.
A recent study in The Permanente Journal examined if electronic health record (EHR) and pharmacy system alerts can influence how opioids are prescribed and dispensed to patients—and how those alerts may help providers follow Centers for Disease Control and Prevention (CDC) guidelines.[1]
"The overprescribing of opioids continues to prolong the epidemic, as taking prescription opioids in higher doses or for longer durations can increase the risk of opioid use disorder, overdose, and death," wrote first author Michelle Nguyen, PharmD, with the department of pharmacy at Kaiser Permanente Mid-Atlantic States in Rockville, Maryland, and colleagues. "Early prescribing patterns for opioid-naïve patients are strong predictors for long-term opioid dependence, forming the rationale for a targeted initiative surrounding judicious prescribing. The likelihood of chronic opioid use rises with each additional day supply of medication beyond 3 days, with the largest incremental increases seen when the first prescription supply exceeds 10 or 30 days."
Nguyen et al. compared data from a six-month period before their EHR and pharmacy alerts were put into place with data from a six-month period after they were put into place. The EHR alert required users to confirm they believe a prescription is appropriate before the request goes through. The pharmacy alert, meanwhile, asked pharmacists to review opioid requests from their own perspective.
Results of deploying alerts
The implementation of alerts within the EHR led to a statistically significant 27% change in opioid prescribing by physicians. This change in prescribing resulted in a reduction in the average day supply of initial opioid prescriptions, dropping from 12.09 days to 6.58 days.
The alert integrated into the pharmacy system had an even more pronounced effect, with a 41.3% change in opioid dispensing. This led to a reduction in the average day supply of dispensed opioids from 13.46 days to 6.96 days.
In short, the findings indicate that clinical support tools and alerts effectively reduce the supply of opioid prescriptions, aligning healthcare practices with the safer opioid use principles at the heart of the CDC's guidelines. However, the sample size for this data analysis was small, which limits the impact of its results.
The overprescribing of opioids continues to prolong the epidemic, as taking prescription opioids in higher doses or for longer duration can increase the risk of opioid use disorder, overdose, and death. Early prescribing patterns for opioid-naïve patients are strong predictors for long-term opioid dependence, forming the rationale for a targeted initiative surrounding judicious prescribing. The likelihood of chronic opioid use rises with each additional day supply of medication beyond 3 days, with the largest incremental increases seen when the first prescription supply exceeds 10 or 30 days
While the findings are promising, further studies are needed to evaluate the true impact these systems have on the supply of opiates. Additionally, the researchers were unable to answer whether the alerts would further decrease continued use of opioids by patients, thus mitigating dependence. Further research is also needed to measure how the reduction of days where opioids are dispensed impacts street supply.
Additional details from the CDC on prescribing opioids for chronic pain are available here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.