Implementation of an Opioid Guideline Impacts on Opioid Prescriptions, Adverse Outcomes, and an Association with a State Opioid-Related Fatalities

J Occup Environ Med. 2019 Aug;61(8):653-658. doi: 10.1097/JOM.0000000000001640.

Abstract

Objective: The aim of this study was to determine the efficacy of an evidence-based opioid guidelines-based program implemented at the largest worker's compensation insurer in Utah.

Methods: All new claims, including surgeries, were included. Pre- and post-intervention comparisons included percentage of claims treated with an opioid, provision of a second opioid prescription, opioid use above 50 mg morphine equivalent dose (MED), opioid use more than 90 mg MED, and opioid use over 90 days.

Results: There were significant (P < 0.001) reductions in all primary outcomes, with a reduction in MEDs in the 18 months after implementation totaling 65,502 mg.

Conclusion: This program significantly reduced the usage of opioids among acute claims. The year of program implementation, Utah experienced a 19.8% reduction in opioid-related fatalities, which may be partly related to the reduction in MEDs. Regardless, this study suggests that the implementation of an evidence-based guideline is impactful and feasible.

MeSH terms

  • Acute Pain / drug therapy*
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Inappropriate Prescribing / prevention & control*
  • Inappropriate Prescribing / trends
  • Insurance Claim Review
  • Occupational Diseases / drug therapy
  • Occupational Injuries / drug therapy
  • Opioid-Related Disorders / mortality
  • Opioid-Related Disorders / prevention & control*
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / trends*
  • Utah / epidemiology
  • Workers' Compensation / trends

Substances

  • Analgesics, Opioid