Department of Pharmacy Services, Hartford Hospital, CT, USA.
University of Connecticut, School of Pharmacy, Storrs, CT, USA.
J Pharm Pract. 2021 Oct;34(5):774-779. doi: 10.1177/0897190020918096. Epub 2020 Apr 15.
To compare opioid prescribing behavior of emergency medicine providers following the enactment of Connecticut Public Act (PA) 15-198 at a large academic tertiary medical center.
This study is a single-center pre and postlaw retrospective cohort of ED patients discharged with opioid prescriptions. Patients discharged from January 1, 2015, to June 30, 2015, were analyzed as the prelaw cohort, and patients discharged from January 1, 2016, to June 30, 2016, were analyzed as the postlaw cohort. The primary outcome was the cumulative dose of solid dosage forms of opioids per prescription, calculated in morphine milligram equivalents (MME).
A total of 10,307 prescriptions included in the final analysis. A statistically significant decrease in the primary outcome was seen in the postlaw cohort compared with the prelaw cohort, respectively (75 MME [interquartile range, IQR: 60-100) vs 80 MME [IQR: 75-150]; < .001). The postlaw cohort also saw 1289 (22.2%) fewer opioid prescriptions, primarily driven by a reduction in the number of schedule II opioids prescribed. In a posthoc analysis, the primary outcome remained statistically significant even when opioid prescriptions were only included if their prebuilt settings were unchanged between pre and postlaw cohorts, respectively (85.1%; 95.6 MME (±56.0); n = 5041 vs 86.7 MME (±39.6); n = 3713; < .001).
The passage of PA 15-198 was associated with a decrease in the cumulative dose of opioids per prescription of solid dosage form products. This drop was precipitated by a transition from using opioids in schedule II to opioids in schedule IV and a modest decrease in prescribed opioid quantity.
在一家大型学术三级医疗中心，比较康涅狄格州公共法案（PA）15-198 颁布后，急诊医学提供者开具阿片类药物的行为。
本研究为单中心、法案前后回顾性队列研究，纳入从 2015 年 1 月 1 日至 2015 年 6 月 30 日出院并开具阿片类药物处方的 ED 患者作为法案前队列，纳入从 2016 年 1 月 1 日至 2016 年 6 月 30 日出院并开具阿片类药物处方的患者作为法案后队列。主要结局是计算每处方的固体剂型阿片类药物的累积剂量，以吗啡毫克当量（MME）表示。
最终分析共纳入 10307 份处方。与法案前队列相比，法案后队列的主要结局明显下降，分别为（75 MME [四分位距，IQR：60-100] 比 80 MME [IQR：75-150]；<0.001）。法案后队列的阿片类药物处方也减少了 1289 份（22.2%），主要原因是开具的 II 类阿片类药物数量减少。在事后分析中，即使仅包括前后两个队列中预先设定不变的阿片类药物处方，主要结局仍具有统计学意义（分别为 85.1%；95.6 MME（±56.0）；n=5041 比 86.7 MME（±39.6）；n=3713；<0.001）。
PA 15-198 的通过与每处方固体剂型产品阿片类药物累积剂量的降低相关。这种下降是由从 II 类阿片类药物过渡到 IV 类阿片类药物以及规定的阿片类药物数量适度减少引起的。
