Stucke RS, et al. - Researchers investigated the influence of the mandatory use of a prescription drug monitoring program on the prescribing practices for patients undergoing elective general surgery. In this pre-post cohort study of 1057 patients, they compared the prescribing practices before and after New Hampshire legislation mandating the use of a prescription drug monitoring program that took effect January 1, 2017. Outcomes suggest no correlation between a mandatory prescription drug monitoring program (PDMP) query requirement and the overall rate of opioid prescribing or the mean number of pills prescribed for patients undergoing general surgical procedures. This suggests that a PDMP can be a useful adjunct in certain settings, but different consideration is required for patients undergoing elective surgical procedures when developing opioid legislation.

Methods

• Researchers performed a prospective observational cohort study at an academic hospital in New Hampshire among 1057 patients undergoing representative elective general surgical procedures from July 1, 2016, to June 30, 2017.
• Exposures included new state legislation mandating the use of a PDMP and opioid risk-assessment tool for all patients receiving an outpatient opioid prescription in New Hampshire beginning January 1, 2017.
• They modified the electronic medical prescribing system to facilitate and support compliance with the new requirements.
• Change in opioid prescribing practices after January 1, 2017, and time to complete PDMP requirements were assessed as the main outcome measures.

Results

• Researchers included 1057 patients (569 women [53.8%] and 488 men [46.2%]; mean [SD] age, 56.8 [15.4] years) in this study.
• No significant decrease in the percentage of patients prescribed opioids after surgery was evident (429 of 536 [80.0%] before the new requirements vs 401 of 521 [77.0%] after the requirements; P=.29).
• A decrease in the mean number of opioid pills prescribed, from 30.8 to 24.0 (22.1%), was observed in the 6 months prior to the mandatory PDMP requirement; the rate of decrease was actually less (from 22.8 to 21.9 pills [3.9%]) in the 6 months after the legislation.
• These new requirements did not identify any high-risk patients who subsequently were not prescribed opioids.
• A median time of 7 minutes was required by the query and opioid abuse risk calculator together (range, 2-17 minutes) to complete.