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Opioid Prescribing Trends before and after Electronic Prescribing for Controlled Substances Legislation

Chaim Miller, Asif M. Ilyas

Background: The opioid epidemic is an ongoing public health crisis in the United States. In response, states have implemented various programs to combat it effectively, including implementation of prescription drug monitoring programs (PDMP) and mandating electronic prescribing (e-Rx) of opioids. However, the effectiveness of e-Rx is poorly understood.

Objective: To examine the trends of opioid prescribing patterns before and after the implementation of an e-Rx mandate in Pennsylvania.

Methods: Data pertaining to opioid prescribing habits as listed below were obtained from the Pennsylvania Department of Health (PA DOH) who administers the PDMP in Pennsylvania. Study data that were of interest and provided by the PDMP were: Drug name, quantity of prescriptions, average daily MME, and days supplied. Prescribing patterns of opioids were compared for a quarter before e-Rx (Q1 2017) compared to a quarter after e-Rx was mandated (Q1 2020).

Results: Pennsylvania saw a 33% decrease in overall quantity of opioid prescriptions and an 18% decrease in the authorized refill count from a quarter prior to e-Rx implementation to the quarter following. The largest absolute decrease in prescriptions was from Oxycodone (258,727 or 29%) and Hydrocodone (236,868 or 39%). There also was a larger decrease in intermediate and longer-term opioid prescriptions (>7 days) compared to short term prescriptions (<7 days) (43% vs 27%).

Discussion: There was a 33% decrease in the total number of opioids prescribed and an 18% decrease in opioid refills authorized between the two quarters before and after mandated implementation of e-Rx of opioids.

Conclusion: Pennsylvania’s numbers of opioid prescriptions continued to decline alongside the implementation of an e-Rx mandate statewide. More research is needed to outline the significance of e-Rx on opioid prescription trends directly.