Mandatory PDMP checks may not be beneficial for surgical patients

Other measures can be considered instead

New data published in JAMA Surgery show that mandating surgeons perform a PDMP query for every postoperative opioid prescription did not decrease the proportion of patients who were given a prescription or the mean number of tablets/capsules prescribed.

“PDMP use has been shown by others to identify drug-seeking patients in other settings; however, it does not intuitively make sense that patients would undergo surgery just to obtain opioids,” said study author Richard J. Barth Jr., MD, from the Department of Surgery at Dartmouth-Hitchcock Medical Center. He noted that the mandatory PDMP query is burdensome and takes a significant amount of time to complete.

“If a patient who is opioid dependent undergoes an operation that requires opioids for management of postoperative pain, then this patient will still need as many pills as a non–opioid-dependent patient,” said Barth. He suggested that other measures should be taken, such as following postoperative opioid prescribing guidelines and considering use of multimodal pain management strategies.

Barth and colleagues conducted a prospective observational study to assess the association of use of a mandatory PDMP query with prescribing practices for patients undergoing elective surgery at an academic hospital in New Hampshire. The researchers noted that the percentage of patients prescribed an opioid did not decrease significantly before the new PDMP requirement (July 1, 2016–December 31, 2016) compared with after the requirement (January 1, 2017––June 30, 2017). Also, the mean number of opioid tablets/capsules prescribed did not change significantly. No high-risk patients were identified with the mandatory check, and the researchers noted that this check along with completion of the opioid abuse risk calculator took a median of about 7 minutes (range, 2–17 min).  

“I think that the pharmacist might make better use of his or her time if they check to see whether the prescription matches guidelines for that operation,” Barth said. He noted that guidelines for outpatient surgeries are available online from the Mayo Clinic and the University of Michigan groups. He also referred to his paper “Guideline for Discharge Opioid Prescriptions After Inpatient General Surgical Procedures,” which gave the following recommendations:

-If no opioid pills are taken the day before discharge, then no prescription is needed.

-If 1 to 3 opioid pills are taken the day before discharge, then a prescription for 15 opioid pills is given at discharge.

-If 4 or more pills are taken the day before discharge, then a prescription for 30 opioid pills is given at discharge.

In this paper, Barth noted that if these recommendations were followed, the number of opioid tablets/capsules prescribed would decrease by 40%.

“Having access to a PDMP registry may be useful to check on patients a surgeon feels to be high risk for abuse, including those who ask for refills, but PDMP use should not be mandated for surgeons until there are data that it is effective. In our study, we did not find it effective,” he said.

For the full article, please visit www.pharmacytoday.org for the November 2018 issue of Pharmacy Today.