An opioid alert system decreased the mean morphine equivalent daily dose (MEDD) of opioid prescriptions written by ophthalmologists at an Ohio clinic by 15.17 MEDD per prescription, according to research published in the American Journal of Ophthalmology.  The researchers also examined the medical records for differences in opioid dosages based on patient demographics and diagnosis.

The retrospective study relied on data from patients given opioid scripts at the Cole Eye Institute in Cleveland between January 2015 and November 2021. 

The opioid alert system, which was implemented in the hospital December 19, 2017, was created after Ohio passed an opioid law in August of that year that called for special alerts when opioid prescriptions exceeded a dosage of 30 MEDD or a 7-day supply. The outcome measures included pre- and post-implementation MEDD data and comparisons of MEDD data between different demographics and diagnoses.


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Researchers collected electronic data of 8014 participants, totaling to 9055 total opioid prescriptions. Of those prescriptions, 77% received opioid prescriptions following ocular surgery. The patients were divided into 3 groups based on the date of their first prescription, with the first group (from January 1, 2015 to December 19,

2017) consisting of 4388 individuals, a second group (December 20, 2017 to March 2, 2020) consisting of 2276 individuals, and a third group (March 3rd 2020 to November 3rd 2021) consisting of 1350 individuals. 

The study shows a mean decrease of 15.17 MEDD per prescription after they initiated the opioid alert system (P <.001). The study shows patients in the first group had a higher mean MEDD per prescription compared with those in the second (β=-15.37, P <.001) and the third (β=-15.35, P <.001). Multivariate analysis also shows the first group had a higher mean MEDD per prescription as compared to the second (β=-15.52, P <.001) and third groups (β=-15.79, P <.001).

The investigators also took the opportunity to conduct a comparison of opioid prescription differences between patient demographic groups. That analysis shows increased mean MEDD per prescription for patients aged 49 to 62 years (33.82 MEDD) compared with the age ranges 63 to 72 years (32.12 MEDD; P <.001) and 73 to 101 years (32.64 MEDD; P =.005). Researchers also noted elevated MEDD per prescription in men (33.53 MEDD; P <.001) and participants who were Black compared with those who were White (33.93 MEDD vs 32.80 MEDD; P =.03). In ophthalmology, most opioid prescriptions written between 2000 and 2016 were for postoperative pain control following incisional ocular surgeries, primarily strabismus, trauma, and retinal surgeries, according to additional research cited in the study. However, this study found disorders of the eyelid, lacrimal system, and orbit had the highest percentage (57.4%) of prescriptions across diagnoses. 

Results indicate that the opioid alert system effectively decreased dosage of opioid prescriptions written by ophthalmologists. Researchers note the increased risk of addiction among younger populations, saying, “Safely lowering dosages for all demographic groups with a focus on groups receiving higher dosages can aid in lowering opioid related deaths while maintaining therapeutic benefit.” Additionally, researchers note the high number of opioid prescriptions given to those with diagnoses of the eyelid, lacrimal system, and orbit do not align with best practice guidelines published within the literature. 

The limitations of this study include the lack of uniformity among cohorts, lack of data regarding the number of prescriptions that were filled by participants, missing background information regarding previous opioid use in participants, and the single institution design.

Reference

Blaga V, Seth K, Valentim C, et al. Opioid prescription in ophthalmology and the impact of a decision support tool in reducing excess dosing. Am J Ophthalmol. Published online July 21, 2022. doi:10.1016/j.ajo.2022.06.019.