University of Wisconsin–Madison Medical College of Wisconsin

Effect of a Statewide Controlled-Substance Monitoring Requirement on the Opioid Prescribing Practice for Treatment of Acute Pain

Brett M. Derleth, PharmD, RPh; Donn D. Dexter, MD; Richard Arndt, PharmD, RPh; Cathy M. Lea, BS Pharm, RPh; Ross A. Dierkhising, MS; Jordan F. Dow, PharmD, RPh

WMJ. 2020;119(1):33-36.

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Background: The US government affirmed the opioid epidemic as a public health emergency in late 2017. Prior to that, as part of the Heroin, Opiate, Prevention, and Education (HOPE) Agenda, the state of Wisconsin enacted 2015 Wisconsin Act 266. This law, which went into effect April 1, 2017, requires prescribers to review data from the state’s enhanced Prescription Drug Monitoring Program (ePDMP) before issuing an opioid prescription, in order to reduce inappropriate prescriptions and, ultimately, decrease opioid overuse.

Objective: To evaluate the effect of 2015 Wisconsin Act 266 on opioid prescriptions for acute pain in Mayo Clinic Health System sites in northwest Wisconsin.

Patients and Methods: This retrospective review included all eligible patients who were discharged from emergency or urgent care departments in the Mayo Clinic Health System at northwest Wisconsin sites during the study period. The quantity of opioids prescribed (measured in morphine milligram equivalents per patient encounter) and the total number of opioid prescriptions were compared for the periods May and June 2016 (prior to implementation of Act 266) versus May and June 2017 (post-implementation of Act 266).

Results: A 33% reduction occurred in the median opioid quantity prescribed per patient encounter in the post-implementation period vs the pre-implementation period (P < .001). In addition, a 13% relative reduction occurred in the percentage of patient encounters that involved an opioid prescription (P < .001). No difference was observed in opioid prescription agents between time periods, except for an increase in morphine prescriptions (P < .001).

Conclusion: The HOPE Agenda, specifically 2015 Wisconsin Act 266, appears to have had a positive effect on decreased opioid prescriptions for acute pain at Mayo Clinic Health System sites in northwest Wisconsin.

Author Affiliations: Pharmacy (Derleth, Arndt, Dow, Lea), Neurology (Dexter), Mayo Clinic Health System, Eau Claire, Wis; Division of Biomedical Statistics and Informatics (Dierkhising), Mayo Clinic, Rochester, Minn.
Corresponding Author: Brett M. Derleth, PharmD, RPh, Pharmacy, Mayo Clinic Health System, 1400 Bellinger St, Eau Claire, WI 54703; phone 715.838.3124; email
Acknowledgment: The authors thank Brian E. Gierhart, BS Pharm, RPh, for his assistance with data collection and analysis and Sarah E. Normand, PharmD, RPh, for her help with the research proposal and manuscript review.
Funding/Support: None declared.
Financial Disclosures: None declared.
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