Opioid Supply Shortages, Prepared Dosages Influence Emergency Department Prescribing Behaviors

External factors, such as the volume of pre-filled syringes or a default number of tablets that could easily be ordered for a patient at discharge, can cause emergency department (ED) physicians to administer or prescribe greater quantities of opioids, according to a study published in the Journal of Medical Toxicology. The study also found that prescribing behavior can be decreased by external factors, such as a supply shortage.

The researchers evaluated pharmacy data from the electronic medical records (EMR) collected before, during, and after a period of parenteral opioid shortage across 2 large urban academic emergency departments. The shortage was of parenteral morphine and hydromorphone, caused by supply chain disruptions from Hurricane Maria in 2018. They found that the percentage of patients who received an opioid among all ED visits during the 2018 shortage fell significantly from 11.5% pre-shortage to 8.5% during, and did not return to baseline once the shortage had ended.

The total number of oral or IV opioid doses administered during the shortage also decreased and remained lower than pre-shortage levels once supply chains were restored, according to the study’s authors. However, the study also found that although fewer opioid doses were administered to fewer patients, there was no change in net morphine milligram equivalent per patient receiving opioids.

“Although the percentage of patients who received nonopioid analgesics did not rise during the shortage, it was significantly higher in the post-shortage period,” said Amanda Deutsch, MD, in a press release. “This suggests that a subset of patients was transitioned to nonopioids, and this prescribing practice was a sustained change after the resolution of the shortage.”

The use of oral morphine appeared to increase during the shortage period, suggesting that the shortage may have led to a shift from IV opioid use to oral opioid formulations. The study also found that parenteral morphine and hydromorphone were replaced by parenteral fentanyl during the shortage, but the overall total use in MME of opioids administered remained the same.

“Changing clinician prescribing behavior is challenging,” said Jeanmarie Perrone, MD, in the press release. “This study shows encouraging data to support that there are environmental modifications that can nudge providers toward more judicious opioid use.”

REFERENCE

Penn study reveals how opioid supply shortages shape emergency department prescribing behaviors [news release]. EurekAlert; May 6, 2021. Accessed May 7, 2021. https://www.eurekalert.org/pub_releases/2021-05/uops-psr050621.php