Opioid Prescribing: Guidelines, Rescheduling, and Mandates

Many states have now taken legislative action to limit first-time prescribing of opioid analgesics for acute pain, some with restrictions of as few as 3-days’ supply. Recently, the US Food and Drug Association has engaged the National Academies of Sciences, Engineering, and Medicine (NASEM) to conduct a review of the various guidelines, identify areas in which justifying evidence is lacking, and highlighting the conditions and procedures for which opioid therapy is most often engaged. Unlike existing guidelines developed by the CDC, the focus of the NASEM work will be on acute pain. The NASEM plans to approach the task via a series of public workshops and meetings with experts and stakeholders.

The need for a more thorough examination of prescribing guidelines for acute pain was reinforced by conclusions from 2 recent studies appearing in the journal JAMA Surgery. One investigation examined the impact of a 2014 DEA action moving hydrocodone-containing analgesics from Schedule III to Schedule II on the amount of these agents prescribed following surgery. A significant increase in the amount of the initial opioid prescription was noted. The authors write that “Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors.” A second study examines the effect on prescribing practice associated with general surgery of 2017 New Hampshire legislation mandating the use of the state prescription drug monitoring program. The researchers found that requiring PDMP consultation had no impact on the overall rate of opioid prescribing or on the mean number of pills prescribed. The authors conclude: “A PDMP can be a useful adjunct in certain settings, but this study found that it did not have the intended effect in a population undergoing elective surgical procedures. Legislative efforts to mandate PDMP use should be targeted to populations in which benefit can be demonstrated.”

Read the journal abstracts here and here.

Other Categories:

• opioids

• pain policy