A systematic review and meta-analysis found that for patients discharged from the emergency department (ED), most interventions aimed at reducing opioid prescriptions successfully reduced the prescription rate but not the prescribed quantity. These findings were published in JAMA Network Open.

Investigators at Hôpital du Sacré-Coeur de Montréal in Canada searched publication databases through March 2021 for studies of opioid reduction interventions for patients discharged from the ED. The primary outcome was the variation in the prescription rate or quantity of opioids.

This review included 63 studies published since 2013 which were conducted in the United States (n=55), Australia (n=5), and Canada (n=3).


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Among studies of prescribing rates, 90% reported a reduction. Of those, 34 out of 46 reached statistical significance. The collective decrease in prescription rate had a significant 6-month step change (-22.61%; 95% CI, -30.70% to -14.52%; I2, 77%) and odds ratio (0.56; 95% CI, 045-0.70; I2, 99%) depending on study design.

For the studies of opioid quantity, 82% reported a reduction and 17 out of 32 reached significance. No collective significant change to the 6-month step changes was identified (-8.64%; 955 CI, -17.48% to 0.20%; I2, 92%), but a small but significant standardized mean difference was observed (-0.30; 95% CI, -0.51 to -0.09; I2, 100%).

Stratified by intervention, the education, policy, or guideline (EPG) intervention associated with greater reduction rates than prescription drug monitoring program or state law (PDMP; P <.001) and EPG, clinician peer comparison (CPC), and PDMP were superior to physical therapy (PT) and electronic medical record quantity change (EMR-QC; P <.001) studies. For prescribed opioid quantities, EPG outperformed PDMP and EMR-QC (P <.001) and PDMP outperformed CPC and EMR-QC (P =.03).

Visual asymmetry was observed for 4 funnel plots assessing publication bias. However, Egger tests were nonsignificant (all P ≥.10).

This study was limited by the broad range of interventions included, likely contributing to the high heterogeneity observed for all comparisons.

“The findings of this meta-analysis suggest that specific interventions may be better at reducing the rate (to a lesser extent in reducing the quantity) of prescribed opioids to patients discharged from the ED. Therefore, policymakers and clinicians should probably focus their efforts on these more promising approaches to reduce prescribing rates,” the study authors concluded.

Reference

Daoust R, Paquet J, Marquis M, et al. Evaluation of interventions to reduce opioid prescribing for patients discharged from the emergency department: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(1):e2143425. doi:10.1001/jamanetworkopen.2021.43425