Opioid e-prescribing trends at discharge in a large pediatric health system

Christopher M. Horvat, MD, MHA; Brian Martin, DMD; Liwen Wu, MS; Anthony Fabio, PhD; Phil E. Empey, PharmD, PhD; Fanuel Hagos, PhD; Sheila Bigelow, DO; Sajel Kantawala, BS; Alicia K. Au, MD MS; Patrick M. Kochanek, MD; Robert S. B. Clark, MD

doi:10.5055/jom.2019.0493

Authors

Christopher M. Horvat, MD, MHA
Brian Martin, DMD
Liwen Wu, MS
Anthony Fabio, PhD
Phil E. Empey, PharmD, PhD
Fanuel Hagos, PhD
Sheila Bigelow, DO
Sajel Kantawala, BS
Alicia K. Au, MD MS
Patrick M. Kochanek, MD
Robert S. B. Clark, MD

DOI:

https://doi.org/10.5055/jom.2019.0493

Keywords:

opioid, children, oxycodone, codeine, drug monitoring program

Abstract

Objective: Legitimate opioid prescriptions have been identified as a risk factor for opioid misuse in pediatric patients. In 2014, Pennsylvania legislation expanded a prescription drug monitoring program (PDMP) to curb inappropriate controlled substance prescriptions. The authors’ objective was to describe recent opioid prescribing trends at a large, pediatric health system situated in a region with one of the highest opioid-related death rates in the United States and examine the impact of the PDMP on prescribing trends.

Design: Quasi-experimental assessment of trends of opioid e-prescriptions, from 2012 to 2017. Multivariable Poisson segmented regression examined the effect of the PDMP. Period prevalence comparison of opioid e-prescriptions across the care continuum in 2016.

Results: There were 62,661 opioid e-prescriptions identified during the study period. Combination opioid/non-opioid prescriptions decreased, while oxycodone prescriptions increased. Seasonal variation was evident. Of 110,884 inpatient encounters, multivariable regression demonstrated lower odds of an opioid being prescribed at discharge per month of the study period (p < 0.001) and a significant interaction between passage of the PDMP legislation and time (p = 0.03). Black patients had lower odds of receiving an opioid at discharge compared to white patients. Inpatients had significantly greater odds of receiving an opioid compared to emergency department (Prevalence Odds Ratio 7.1 [95% confidence interval: 6.9-7.3]; p < 0.001) and outpatient (398.9 [355.5-447.5]; p < 0.001) encounters.

Conclusion: In a large pediatric health system, oxycodone has emerged as the most commonly prescribed opioid in recent years. Early evidence indicates that a state-run drug monitoring program is associated with reduced opioid prescribing. Additional study is necessary to examine the relationship between opioid prescriptions and race.

Author Biographies

Christopher M. Horvat, MD, MHA

Department of Critical Care Medicine and the Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania

Brian Martin, DMD

Department of Pediatric Dentistry, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania

Liwen Wu, MS

Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania

Anthony Fabio, PhD

Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania

Phil E. Empey, PharmD, PhD

Division of Pharmacy and Therapeutics, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania

Fanuel Hagos, PhD

Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania

Sheila Bigelow, DO

Bellevue Pediatric Associates, Children’s Community Pediatrics, Pittsburgh, Pennsylvania

Sajel Kantawala, BS

Information Services, Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania

Alicia K. Au, MD MS

Department of Critical Care Medicine and the Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania

Patrick M. Kochanek, MD

Department of Critical Care Medicine and the Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania

Robert S. B. Clark, MD

Department of Critical Care Medicine and the Brain Care Institute, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania

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