Opioid overdose deaths have increased substantially over the past fifteen years. I characterized the experience of the medical community and measured the multi-level factors influencing opioid prescribing within the context of legislation and clinical decision support interventions.
My content analysis of letters to the editor in JAMA demonstrated that physicians seek to balance pain management and the adverse effects of opioids. Physicians took ownership of their role in the epidemic but called upon the government and community to help address the issue.
My interrupted time series study revealed that legislation resulted in patients with acute musculoskeletal injury (n=12,918) having 17.7% increased frequency (p<0.001) of receiving a perception for <7 days, climbing to 77.1% of all opioid prescriptions. Physician and facility characteristics accounted for 30% and 9% of the observed variation, respectively.
A clinical decision support intervention lowered the percent of patients with chronic musculoskeletal conditions (n=1,290,746) receiving an opioid by 1.6% (p=0.0002) but had no effect on dose. Practice accounted for 24% of the variation in safe opioid prescribing scores.
Collectively, this research presents a sophisticated and nuanced understanding of the multi-level factors which influence guideline-concordant opioid prescribing. These data can inform tailored interventions and guide decision-making and policy.