The following is a summary of “Impact of Prospective, System-wide Intervention to Influence Opioid Prescribing Practices Among Patients with Back Pain,” published in the September 2024 issue of Emergency Medicine by Owens et al.

In response to the opioid epidemic, the team developed a risk-based intervention that used patient data to identify potential opioid misuse and provide targeted support based on 5 evidence-based risk factors (early refill of opioids/benzodiazepines; >2 ED/Urgent Care visits with onsite opioids; >3 prescriptions of opioids/benzodiazepines; prior overdose; and positive toxicology screen).

Researchers conducted a retrospective study to assess the effect of the intervention on prescribing decisions for back pain by measuring the percentage of opioid prescriptions in response to the alert.

They calculated rates of “decision influenced” (modifying or canceling prescriptions) in response to the PRIMUM intervention and characterized patients, encounters, and prescriptions in this population of 93,192 adult patients with complaints of back pain from 2017-2021.

The results showed 30.2% of patients with back pain received an opioid prescription, with 18.6% having a risk factor. An alert was fired in 6,501 (19.8%) encounters, and positive toxicology was the most common risk factor (52.1%). The prescriber decision was influenced in 430 of these encounters overall (6.6%) and was highest for 3 or more prescriptions in the past month (11.8%) and early refill (9.1%). Chronic patients were more likely to receive opioids.

They concluded that 1 in 3 patients received opioids in the emergency department, and a clinical decision supporting intervention had little impact on opioid prescribing for this population.

Source: jem-journal.com/article/S0736-4679(24)00267-1/abstract