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Prescription opioid use has risen steeply for over two decades, driven primarily by advocacy for better management of chronic non-cancer pain, but also by poor opioid stewardship in the management of acute pain. Inappropriate prescribing, among other things, contributed to the opioid ‘epidemic’ and striking increases in patient harm. It has also seen a greater proportion of opioid-tolerant patients presenting to acute care hospitals. Effective and safe management of acute pain in opioid-tolerant patients can be challenging, with higher risks of opioid-induced ventilatory impairment and persistent post-discharge opioid use compared with opioid-naive patients. There are also increased risks of some less well known adverse postoperative outcomes including infection, earlier revision rates after major joint arthroplasty and spinal fusion, longer hospital stays, higher re-admission rates and increased healthcare costs. Increasingly, opioid-free/opioid-sparing techniques have been advocated as ways to reduce patient harm. However, good evidence for these remains lacking and opioids will continue to play an important role in the management of acute pain in many patients. Better opioid stewardship with consideration of preoperative opioid weaning in some patients, assessment of patient function rather than relying on pain scores alone to assess adequacy of analgesia, prescription of immediate release opioids only and evidence-based use of analgesic adjuvants are important. Post-discharge opioid prescribing should be contingent on an assessment of patient risk, with short-term only use of opioids. In partnership with pharmacists, nursing staff, other medical specialists, general practitioners and patients, anaesthetists remain ideally positioned to be involved in opioid stewardship in the acute care setting.

The U.S. opioid crisis necessitates that health care providers of all types work collaboratively to manage patients taking prescription opioid medications and manage those who may be misusing prescription opioids. Musculoskeletal conditions are the most common diagnoses associated with an opioid prescription. Physical therapists commonly manage patients with musculoskeletal conditions and chronic pain. Some patients who attend physical therapy for pain management take prescription opioid medications for pain and some of these patients may be misusing prescription opioids. Physical therapists who manage patients with musculoskeletal conditions are well-positioned to help address the opioid crisis. Historically, physical therapists have not been adequately engaged in efforts to manage persons with co-occurring musculoskeletal pain and opioid misuse or OUD. The American Physical Therapy Association (APTA) has emphasized physical therapy over the use of prescription opioids for the management of painful conditions. The APTA, however, does not highlight the important role that physical therapists could play in monitoring opioid use among patients receiving treatment for pain, nor the role that physical therapists should play in screening for opioid misuse. Such screening could facilitate referral of patients suspected misuse to an appropriate provider for formal assessment and treatment. This commentary presents simulated musculoskeletal patient presentations depicting 2 common opioid use states; chronic opioid use and opioid misuse. The cases highlight and interactions that physical therapists could have with these patients and actions that the physical therapist could take when working inter-disciplinarily. Recommendations are provided that aim to increase physical therapists’ knowledge and skills related to managing patients taking prescription opioid medications for pain.

This study examines the relationships between prescription opioid pills, unemployment, health insurance, and theft. Covering the years 2006–2012, our data are an aggregate of information from the Drug Enforcement Administration, the Federal Bureau of Investigation’s National Incident-Based Reporting System, and the American Community Survey (ACS). The unit of analysis is time nested within counties. Preliminary results demonstrate that there were approximately 46 prescription opioid pills distributed per person annually in the United States between 2006 and 2012. Multivariate results reveal that counties with higher numbers of prescription opioid pills tend to experience significantly higher patterns of theft. Interestingly, health insurance is positively associated with theft while unemployment appears to protect against theft. The relationship between pills and theft is also conditioned by both unemployment and health insurance. Future research should explore these relationships to better inform efforts at making responsible social policy in the midst of the opioids crisis.

Introduction: Opioid crisis has disproportionately affected Alabamians with the highest opioid prescription rate, and it is subjected to affect Korean Americans (KA) negatively based on common predictors of opioid misuse that KA possess. Method: Cross-sectional data of KA in rural Alabama ( N = 230) were analyzed. Opioid literacy was assessed by the Brief Opioid Overdose Knowledge survey. Six social determinants of health factors were considered: financial status, educational attainment, English proficiency, household food insecurity, health literacy, and social contact. Results: Participants had limited opioid literacy ( M = 3.56, SD = 3.06). After adjusting for demographics and health covariates, higher levels of overall opioid literacy were associated with higher household income ( B = .48, p < .01), higher levels of health literacy ( B = .71, p < .01), and less frequent social contact ( B = −.40, p < .01). Significant social determinants of health predictors varied across subdomains of opioid literacy. Discussion: The findings suggest that culturally competent and community-level interventions are needed to increase opioid literacy in KA in rural Alabama.

Background Prescription drug monitoring programs (PDMPs) are tools that states can use to fight prescription opioid misuse within their jurisdiction. However, because PDMPs make prescription opioids more difficult to access, these programs may have the unintended consequence of increasing deaths related to illicit opioids. Methods This study uses fixed effects models to estimate how PDMP regulatory strength is associated with both prescription opioid- and heroin-related deaths between 1999 and 2016. PDMP regulatory strength is measured by creating a score using multiple correspondence analysis (MCA). Additional models replace the MCA score with a binary indicator for the presence of one particular regulation requiring physicians to access the system before writing opioid prescriptions. Results Results show that continuous measures of PDMP strength are not generally associated with prescription opioid- or heroin-related death rates. Yet, one model does show that PDMP scores are positively associated with the heroin-related death rate. The models using the binary mandatory access variable show a strong positive association with both prescription opioid and heroin deaths. Conclusions This study supports the theory that more stringent state PDMPs are associated with higher rates of heroin-related deaths, potentially due to decreases in prescription opioid availability.

To date, studies have found scattered and inconsistent use of existing opioid prescription support tools, such as Prescription Drug Monitoring Systems (PDMPs) and guidelines, and little research has been done to identify barriers for adopting them and better ways to support clinician decision making. This pilot study aims to better understand the flow, resources used, and challenges faced when prescribing opioid medications. The study will help shape research questions for a larger study geared towards informing future decision aid designs and considerations for clinicians in the emergency department (ED). Semi-structured interviews were conducted with a total of six emergency medicine physicians and nurses using an abbreviated variant of the Critical Decision Method. Discussions were focused around how participants made their decisions and what was difficult about them, in addition to whether current aids and tools are helpful. Common themes were identified from free-text notes in the following categories: cognitive and communication challenges, challenges with existing tools and databases, and decision-making strategies. Nurse responses were most commonly related to gaps in communication between physicians and patients and ensuring patient satisfaction. Physicians most commonly reported challenges with existing tools. While existing resources were said to be very helpful, several improvements were suggested by each group. By understanding these types of challenges and dynamics between physicians and nurses in the ED, we can better identify ways to improve the design of opioid prescription decision-making aids in the future.

Study Design: Retrospective case series. Objectives: To evaluate the variability in opioid prescription following primary single-level lumbar microdiscectomy. Methods: We retrospectively reviewed consecutive patients who underwent primary single-level lumbar microdiscectomy. Only opioid-naïve patients ≥18 years old were included. Patients who had revision microdiscectomy, multilevel decompression, and/or any complication requiring prolonged hospital stay (>2 days) were excluded. The primary outcomes were the maximum daily dosage of opioids prescribed in morphine milligram equivalents (MME) and the number of pills prescribed (equivalent to 5 mg hydrocodone). Results: Between 2014 and 2019, 169 patients (90 men, 79 women) met inclusion criteria, with a mean age of 46.9 years. Surgery resulted in a statistically significant improvement in VAS (Visual Analogue Scale) score (6.4 to 2.5, P < .01). At discharge, 8 patients (4.7%) did not receive any opioid prescription. Of the remaining 161 patients, 1 patient (0.01%) received hydromorphone, 30 (18.6%) Percocet, 43 (26.7%) oxycodone, and 87 Norco (54.0%). The length of opioid prescription was 6.7 days. The maximum daily dosage of opioids prescribed was 70.4 MME (SD 32.1). The total number of pills prescribed was 89.4 (SD 54.7). Twenty-five patients (15.5%) received a refill prescription. Multivariate analysis demonstrated the operating service, prescriber, and hospital admission were statistically significant predictors of maximum daily MME. The prescriber and hospital admission were statistically significant predictors of total number of pills prescribed. Conclusions: We found significant variability in opioid prescription following primary single-level lumbar microdiscectomy. For standard spinal procedures like lumbar microdiscectomy, opioid-prescribing guidelines should be established to standardize postoperative pain management.

Background Since 1999, >200 000 people in the United States have died from a prescription opioid overdose. Lower socioeconomic status (SES) is one important risk factor. This study investigates socioeconomic disparities in postoperative opioid prescription and consumption. Methods September 2018-April 2019, 128 patients were surveyed postoperatively regarding opioid consumption. The neighborhood disadvantage was calculated using area deprivation index (ADI). The top 3 quartiles were “high SES” and the bottom quartile “low SES.” Results The study population included 96 high SES patients, median ADI 6 (2-12.3) and 32 low SES, median ADI 94.5 (81.3-97.3). For both, median Oxycodone 5 mg prescribed was 20 pills. 29.2% of high SES consumed 0 pills, 40.6% consumed 1-9 pills, and 27.1% consumed 10+ pills. 25.0% of low SES consumed 0 pills, 46.9% consumed 1-9 pills, and 18.8% consumed 10+ pills. No significant difference in opioid prescription ( P = .792) or consumption ( P = .508) between SES groups. Discussion Patients of all SES are prescribed and consumed opioids in similar patterns with no significant difference in postoperative pain following ambulatory surgery.

The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.

Introduction: To determine the prevalence of prescription opioid (PO) use among Hispanics/Latinos with arthritis symptoms and to characterize how demographic and cultural factors are associated with PO use. Method: Cross-sectional analysis of baseline visit data during 2008 to 2011 from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study of 16,415 Hispanics/Latinos living in Chicago, Illinois, Miami, Florida, Bronx, New York, and San Diego, California. Included participants self-reported painful inflammation or swelling in one or more joints. Multivariate models controlling for physical and mental health scores were constructed to assess how demographic and cultural factors were associated with PO use. Results: A total of 9.3% were using POs at the time of the baseline visit. In multivariate models, persons of Cuban background (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI; 0.21, 0.81]) and of Dominican background (AOR = 0.38, 95% CI [0.18, 0.80]) were significantly less likely to use POs compared with a reference group of persons of Mexican background. Greater language acculturation was also negatively associated with PO use (AOR = 0.68, 95% CI [0.53, 0.87]). Conclusion: POs were used relatively uncommonly, and use showed marked variation between Hispanic/Latino groups. Future study should determine mechanisms for why greater use of English among Hispanics/Latinos might influence PO use.

Background: In 2016, our provider group adopted an initial prescription opioid maximum guideline to reduce overprescription of opioids. The purpose of this study was to prospectively assess opioid consumption patterns following implementation of this guideline in patients undergoing outpatient foot and ankle surgery. Methods: Over a 1-year period, we prospectively analyzed opioid prescription and use patterns of 303 consecutive patients. Opioid consumption was verified by pill counts completed at the 2- and 6-week postoperative visits. The morphine equivalent dose was calculated for each prescription and converted to the equivalent 5-mg oxycodone “pill.” We used the regression coefficients from a regression model of opioid consumption to create a revised guideline for maximum initial opioid prescriptions based on patient age, bony vs nonbony procedure, and anatomic location (forefoot/midfoot/hindfoot/ankle). Results: On average, 37.4 pills were prescribed and 18.9 pills used (47.6% utilization). Only 17.2% of patients used their full prescription quantity. By 2 weeks, 88% of patients no longer used opioids. Only 1.3% of patients used prescription opioids beyond 6 weeks. Independent risk factors for increased opioid consumption were younger age ( P = .003), male sex ( P = .007), recent preoperative opioid use ( P = .019), bony procedures ( P < .001), and ankle/hindfoot procedures ( P = .016 and P < .001). Conclusion: This study showed the amount of opioid consumption for patients undergoing foot and ankle procedures. We present a modified guideline for the maximum initial prescription of opioids following outpatient foot and ankle procedures that can be used as a benchmark for further study in decreasing overprescribing. Level of Evidence: Level II, prospective observational cohort study.

Background The purpose of this study was to describe dentists’ training experiences relevant to pain management, addiction, and prescription opioid drug diversion and examine associations between these training experiences and dentists’ opioid prescribing practices. Methods A Web-based, cross-sectional survey was conducted among practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822). The survey assessed pain management prescribing practices and training experiences related to pain management and assessment for addiction and drug diversion. Survey data were linked with National Dental PBRN Enrollment Questionnaire data regarding practitioner demographics and practice characteristics. Results The majority of dentists (67%) reported prior training in pain management; however, a minority of dentists reported prior training regarding identification and assessment of drug abuse or addiction (48%) or identification of prescription drug diversion (25%). The majority of training experiences across all topics occurred through continuing dental education participation. Dental school training relevant to pain management, addiction, and identification of drug diversion was more prevalent among more recent dental school graduates. Training experiences were associated with prescribing practices. Conclusions Results suggest that across multiple levels of training, many dentists are not receiving training specific to addiction assessment and identification of drug diversion. Such training is associated with greater consistency of risk mitigation implementation in practice.

Opioid use claims many thousands of lives each year. This article considers the diffusion of prescription opioid (PO) use within family households as one potential culprit of the proliferation of these medications. In an analysis of hundreds of millions of medical claims and almost 14 million opioid prescriptions in one state between 2010 and 2015, we show that the use of POs spreads within family households. We also show that the treatment effect of exposure to a family member’s PO use is driven by an increase in PO consumption for medical conditions that members of treated and untreated families experience at nearly identical rates. This pattern of results suggests household exposure causes an uptick in patient demand for prescription opioids. We use an instrumental variable estimation strategy to address the well-known challenges to estimating a causal effect of intra-household contagion, such as genotypic similarities among family members, assortative matching in partner selection, and clustering of health conditions within households. The results spotlight the salience of the most ubiquitous social structure, the family household, in accelerating opioid consumption to unprecedented levels. The findings also suggest that rather than direct social influence between physicians, the spread of prescription behavior in physician networks may be driven by shifts in patient demand that propagate through the patient sharing network.

Objective. Our objective was to examine the impact of the U.S. FDA’s 2013 black box warning against codeine on codeine and other opioid prescription filling after pediatric tonsillectomy and/or adenoidectomy (T/A) overall and by child race and provider urbanity/rurality. Methods. Patients ≤ 18 who underwent T/A in 8/2011 to 8/2016 were identified in Ohio Medicaid claims. Interrupted time series analyses were used to evaluate the impact of the FDA warning on codeine or other opioid prescription filling post-T/A. Results. In August 2011, codeine prescription filling was lower among black than white children ( P

Approximately 25.3 million adults in the U.S. take prescription opioid medication to provide relief from their daily pain. Over-prescription of these medications has contributed to the opioid epidemic in the U.S. Many patient desire tapering opioids. However, guidelines of opioid tapering are complex and difficult to translate into practice at the point of care. Our research used human factors methods, including participatory ergonomics, task analysis, interviews, and usability testing to design a provider app to aid safe opioid tapering. We present preliminary prototypes of our app that is currently being deployed across a large 10-hospital healthcare system in the mid-Atlantic region. Our app will be integrated into the electronic health record and comprises five sections: Patient Context, Taper Settings, Create Taper Plan, Withdrawal and Non-opioid Pain Plan, and Summary Dashboard.

Background: There are few large database studies on national trends in regional anesthesia for various arthroscopic shoulder procedures and the effect of nerve blocks on the postoperative rate of opioid prescription filling. Hypothesis: The use of regional nerve block will decrease the rate of opioid prescription filling after various shoulder arthroscopic procedures. Also, the postoperative pattern of opioid prescription filling will be affected by the preoperative opioid prescription-filling history. Study Design: Cohort study; Level of evidence, 3. Methods: Patient data from Humana, a large national private insurer, were queried via PearlDiver software, and a retrospective review was conducted from 2007 through 2015. Patients undergoing arthroscopic shoulder procedures were identified through Current Procedural Terminology codes. Nerve blocks were identified by relevant codes for single-shot and indwelling catheter blocks. The blocked and unblocked cases were age and sex matched to compare the pain medication prescription-filling pattern. Postoperative opioid trends (up to 6 months) were compared by regression analysis. Results: We identified 82,561 cases, of which 54,578 (66.1%) included a peripheral nerve block. Of the patients who received a block, 508 underwent diagnostic shoulder arthroscopy; 2449 had labral repair; 4746 had subacromial decompression procedure; and 12,616 underwent rotator cuff repair. The percentage of patients undergoing a nerve block increased linearly over the 9-year study period ( R 2 = 0.77; P = .002). After matching across the 2 cohorts, there was an identical trend in opioid prescription filling between blocked and unblocked cases ( P = .95). When subdivided by procedure, there was no difference in the trends between blocked and unblocked cases ( P = .52 for diagnostic arthroscopies; P = .24 for labral procedures; P = .71 for subacromial decompressions; P = .34 for rotator cuff repairs). However, when preoperative opioid users were isolated, postoperative opioid prescription filling was found to be less common in the first 2 weeks after surgery when a nerve block was given versus not given ( P < .001). Conclusion: An increasing percentage of shoulder arthroscopies are being performed with regional nerve blocks. However, there was no difference in patterns of filled postoperative opioid prescriptions between blocked and unblocked cases, except for the subgroup of patients who had filled an opioid prescription within 1 to 3 months prior to shoulder arthroscopy. Future research should focus on recording the amount of prescribed opioids consumed in national databases to reinforce our strategy against the opioid epidemic.

The aim of this study was to assess postoperative opioid prescribing patterns, usage, and pain control after common vascular surgery procedures in order to develop patient centered best-practice guidelines. We performed a prospective review of opioid prescribing after seven common vascular surgeries at a rural, academic medical center from December 2016 to July 2017. A standardized telephone questionnaire was prospectively administered to patients ( n = 110) about opioid use and pain management perceptions. For comparison we retrospectively assessed opioid prescribing patterns ( n = 939) from July 2014 to June 2016 normalized into morphine milligram equivalents (MME). Prescribers were surveyed regarding opioid prescription attitudes, perceptions, and practices. Opioids were prescribed for 78% of procedures, and 70% of patients reported using opioid analgesia. In the prospective group, the median MMEs prescribed were: VEIN (31, n = 16), CEA (40, n = 14), DIAL (60, n = 17), EVAR (108, n = 8), INFRA (160, n = 16), FEM TEA (200, n = 11), and OA (273, n = 4). The median proportion of opioids used by patients across all procedures was only 30% of the amount prescribed across all procedures (range 14–64%). Patients rated the opioid prescribed as appropriate (59%), insufficient (16%), and overprescribed (25%), and pain as very well controlled (47%), well controlled (47%), poorly controlled (4%), and very poorly controlled (2%). In conclusion, we observed significant variability in opioid prescribing after vascular procedures. The overall opioid use was substantially lower than the amount prescribed. These data enabled us to develop guidelines for opioid prescribing practice for our patients.

Background/aims: Given high rates of depression and suicide among marginalized women, and increasing calls to integrate trauma-informed biomedical and community-led structural interventions, this study longitudinally examines the potential moderating effect of psychedelic use on the relationship between other illicit drug use and suicide risk. Methods: Data (2010–2017) were drawn from a community-based, prospective open cohort of marginalized women in Vancouver, Canada. Extended Cox regression analyses examined the moderating effect of psychedelic use on the association between other illicit drug use and incidence of suicidal ideation or attempt over follow-up. Results: Of 340 women without suicidal ideation or attempt at baseline, 16% ( n=53) reported a first suicidal episode during follow-up, with an incidence density of 4.63 per 100 person-years (95% confidence interval 3.53–6.07). In unadjusted analysis, psychedelic use moderated the relationship between prescription opioid use and suicide risk: among women who did not use psychedelics, prescription opioid use increased the hazard of suicide (hazard ratio 2.91; 95% confidence interval 1.40–6.03) whereas prescription opioid use was not associated with increased suicidal ideation or attempt among those who used psychedelics (hazard ratio 0.69; 95% confidence interval 0.27–1.73) (interaction term p-value: 0.016). The moderating effect of psychedelics remained significant when adjusted for confounders (interaction term p-value: 0.036). Conclusions: Psychedelic use had a protective moderating effect on the relationship between prescription opioid use and suicide risk. In the context of a severe public health crisis around prescription opioids and lack of addiction services tailored to marginalized women, this study supports calls for innovative, evidence-based and trauma-informed interventions, including further research on the potential benefits of psychedelics.

Prescription opioid medications continue to be abused on an epidemic level and have been shown to be a “gateway” drug to heroin abuse. Individuals experimenting with opioids commonly fall in the 10- to 19-year age range in which dentists are the highest prescribers. To reduce the number of excess opioids, the Department of Oral and Maxillofacial Surgery, University of Minnesota, developed and implemented an evidence-based opioid prescribing policy. Data were collected via electronic health record for the previous year and compared with the year following the protocol implementation. The results showed a drastic decrease (>46%) in the number of prescriptions given over a 1-year period. All departments reported a decrease in opioid prescriptions and the average number of tablets per prescription. The concern of undertreating pain was not found to be significant, as there was no increase in after-hours calls, recall appointments, or documentable emergency room visits. The results support the efficacy of an opioid prescribing policy's ability to lower the frequency and number of opioids given to patients, while still adequately treating patients’ pain. Continued evaluation and modifications of the protocol and close monitoring of prescriber habits will enhance patients’ pain control while also limiting the number of opioids available for abuse.

Background: To date, Atrius Health has not assessed how often patients request additional pain medication after receiving an initial opioid for acute pain management. This assessment was requested to help justify prescribing patterns for opioids in the primary care setting. Objective: To assess the amount of requests for additional opioid prescriptions in patients who received a short-acting opioid for acute pain management. Methods: This was a retrospective chart review of a multicenter large ambulatory care organization in the Greater Boston Area. Atrius Health patients who received an initial prescription for a short-acting oral opioid indicated for acute pain management between May 1, 2016, and October 1, 2016, were included in the study. Results: The overall percentage of patients requesting additional medication for acute pain management was 13% (46/350). Of the 46 patients who requested additional medication, 15 patients received a second opioid prescription (33%, 15/46). For those patients who requested additional pain medication, there were no trends between the day supply that was prescribed and a patient receiving a second opioid prescription from a health care provider. Patients who received a 4- to 5-day supply of opioids were not more likely to call back requesting additional pain medication than patients who received a 1- to 3-day supply of opioids (odd ratio = 0.41; 95% confidence interval = 0.17-1.00). Conclusion: At Atrius Health, roughly 13% of patients are requesting additional pain medications after being prescribed a short-acting opioid for acute pain management. Other primary care and urgent care health systems may consider reducing the day supply of opioids prescribed for acute pain management.

Background Misuse and diversion of opioids have contributed to the U.S. opioid crisis, making an understanding of specialty-specific and procedure-specific trends essential. Objective The objective of this analysis was to evaluate nationwide trends in opioid prescribing patterns among sinus surgeons performing functional endoscopic sinus surgery and maxillary sinus balloon dilation, specifically examining factors associated with variations. Methods High-volume sinus surgeons were identified through the Centers for Medicare and Medicaid Services database and cross-referenced against prescriptions to Medicare Part D beneficiaries during 2013 through 2015. Number of opioid prescriptions, prescription lengths, and demographic information were obtained. Results This cohort of 570 surgeons wrote 21,042 opioid prescriptions (5.4 days per prescription) in 2015, with 80.3% and 54.7% writing >10 and >25 prescriptions, respectively. Surgeons writing a greater amount of prescriptions wrote lengthier courses throughout all 3 years ( P = .01, P = .002, P = .003). Female otolaryngologists wrote lengthier prescriptions (6.2 vs 5.3 days, P = .01). Early career otolaryngologists (≤10 years) offered fewer prescriptions compared to those who had greater experience (31.1 vs 39.3, P = .02). Moreover, 73.6% of fellowship-trained otolaryngologists offered >10 prescriptions versus 82.7% of nonfellowship-trained otolaryngologists ( P = .02). Practitioners in the South on average prescribed the greatest amount of opioids ( P Conclusion A majority of sinus surgeons prescribe ≥25 opioid prescriptions annually, with otolaryngologists who write a greater amount of prescriptions writing lengthier courses. As the mean opioid prescription length is 5.4 days, recent legislation limiting opioid prescriptions to 5 days may only have a modest impact for preventing the diversion of perioperative opioid prescriptions. These data suggest further standardized guidelines may be beneficial in elucidating the appropriate indications for the prescription of opioids among sinus surgeons.

Background Prescribers and community pharmacists commonly perceive prescription opioid abuse to be a problem in their practice settings and communities. Both cohorts have expressed support for interventions that improve interprofessional communication and reduce prescription opioid abuse. The objective of this study was to describe prescription opioid abuse-related communication among and between prescribers and community pharmacists in South Central Appalachia. Methods The investigators conducted five focus groups with 35 Appalachian Research Network practice-based research network providers between February and October, 2014. Two prescriber-specific, two pharmacist-specific, and one interprofessional (prescribers and pharmacists) focus groups were conducted, recorded, and transcribed. Data collection and analysis occurred iteratively. Emerging themes were inductively derived and refined. Five member-checking interviews were conducted to validate themes. Results Providers noted several factors that influence intraprofessional and interprofessional communication, including level of trust, role perceptions, conflict history and avoidance, personal relationships, and prescription monitoring program use. Indirect communication approaches via patients, office staff, and voicemail systems were common. Direct pharmacist to prescriber and prescriber to pharmacist communication was described as rare and often perceived to be ineffective. Prescriber to pharmacist communication was reported by prescribers to have decreased after implementation of state prescription monitoring programs. Difficult or uncomfortable conversations were often avoided by providers. Conclusions Interprofessional and intraprofessional prescription opioid abuse communication is situational and influenced by multiple factors. Indirect communication and communication avoidance are common. Themes identified in this study can inform development of interventions that improve providers’ intra- and interprofessional communication skills.

Background:Surgeons and health care systems have received a call to action in an effort to curtail the current opioid epidemic.Purpose:To (1) define the natural history of opioid demand after anterior cruciate ligament reconstruction (ACLR), (2) consider how filling preoperative opioid prescriptions affects opioid demand after ACLR, and (3) evaluate the effect of additional procedures during ACLR and patient age on postoperative opioid demand.Study Design:Cohort study; Level of evidence, 3.Methods:ACLRs performed in the Humana database between 2007 and 2014 were identified using Current Procedural Terminology code 29888. Patients were considered preoperative opioid users if they had filled an opioid prescription in the 3 months preceding surgery. Patients were defined as “chronic” opioid users if they had filled a prescription preoperatively at 1 to 3 months from surgery. Further categorization was performed by identifying patients who only underwent ACLR with no other procedures, those who underwent ACLR with meniscus repair, those who underwent ACLR with meniscectomy, and those who underwent ACLR with microfracture. Categorization by age was also performed. The relative risk (RR) of postoperative opioid use was calculated, and 95% CIs were determined.Results:Over the course of the study period, 4946 ACLRs were performed. At 3 months after their procedure, 7.24% of patients were still filling opioid prescriptions. At 9 and 12 months postoperatively, 4.97% and 4.71% of patients, respectively, were still filling opioid prescriptions. Nearly 35% of patients (1716/4946) were filling opioid pain prescriptions in the 3 months before ACLR. Those filling preoperative opioid prescriptions were 5.35 (95% CI, 4.15-6.90) times more likely to be filling opioid prescriptions at 3 months after ACLR than nonusers (15.38% vs 2.88%, respectively). Those filling opioid prescriptions chronically before surgery were at a 10.50 (95% CI, 7.53-14.64) times increased risk of filling postoperative opioid prescriptions at 5 months. At 5 months postoperatively, patients undergoing ACLR with microfracture had a 1.96 (95% CI, 1.34-2.87) increased risk of filling opioid prescriptions compared with ACLR alone, 2.38 (95% CI, 1.48-3.82) increased risk compared with ACLR with meniscus repair, and 1.51 (95% CI, 1.04-2.19) increased risk compared with ACLR with meniscectomy. Patients younger than 25 years of age had an increased risk of filling opioid prescriptions after ACLR at all time points of the study.Conclusion:Opioid demand after ACLR dropped significantly in the vast majority of patients by the third postoperative month. Surprisingly, 35% of patients undergoing ACLR were observed to be using opioid medication preoperatively, and this study found preoperative opioid use to be a strong predictor of postoperative opioid demand with a 5- to 7-fold increased risk in this patient population. Patients who were filling opioid prescriptions 1 to 3 months from their surgical date were at the highest risk for postoperative opioid utilization. Patients undergoing ACLR with microfracture were at an increased risk of filling opioid prescriptions. Patients less than 25 years of age were at an elevated risk of filling opioid prescriptions at all time points postoperatively.

Background: Residents feel unprepared to care for patients with chronic pain on long-term opioids who exhibit signs of prescription opioid misuse. Objective: Describe an educational intervention for internal medicine residents to improve confidence, practices, attitudes, and self-reported knowledge of resources for chronic pain and opioid misuse. Methods: The intervention included 2 sessions. Session 1 (3 hours): a lecture on chronic pain, prescription opioid misuse, and opioid use disorders and communication skills practice. The residents were asked to use one of these skills during the following week. Session 2 (1.5 hours): debriefing of patient encounters and overview of: prescription opioid monitoring strategies, discontinuation of prescription opioids when appropriate, and treatment for opioid use disorders. Pre- and post-assessments evaluated change in residents’ safe opioid prescribing confidence, self-reported practices, attitudes, and self-reported knowledge of available patient resources. Results: Ninety-one residents completed the intervention, with 44 and 43 completing the pre- and post-assessments, respectively. Utilizing a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree 4 = strongly agree), residents reported improved confidence in skills managing patients with chronic pain (3.0 vs. 2.4, P < .0001), skills identifying which patients with chronic pain have developed an opioid use disorder (3.0 vs. 2.4, P < .0001), and understanding how to monitor for benefit versus harm (3.0 vs. 2.5, P < .0005). They also noted improved ability identifying resources for patients with chronic pain and opioid use disorders. There was a nonsignificant improvement in resident reported comfort talking to patients about the need to discontinue opioids. Residents did not report an increase in use of safe opioid prescribing monitoring strategies or feelings of support in their prescribing decisions by preceptors. Conclusions: A brief training can improve residents’ self-reported knowledge and confidence in managing patients with chronic pain and safe opioid prescribing practices. How this change in confidence affects patient care requires further study.

Objective: This study examines current practices, experiences, beliefs, concerns regarding negative outcomes and confidence of non-pain specialty anaesthetists regarding prescribing opioids to chronic pain patients. Design: An electronic cross-sectional survey was conducted by physicians from the Division of Anaesthesiology, excluding pain specialists, at the Singapore General Hospital. Methods: An online survey was conducted, investigating: (a) sociodemographic and practice characteristics; (b) current opioid prescribing practices; (c) experiences and beliefs towards prescribing opioid analgesics for chronic non-malignant pain; (d) confidence and comfort when prescribing opioids; and (e) educational and training needs in chronic pain management. Results: A total of 123 anaesthetists (80.9%) responded to the survey. It was noted that only 38.2% of respondents were comfortable managing patients with chronic pain. The majority (86.2%) felt that anaesthetists should be the primary doctors in the management of postoperative pain in chronic pain patients, and 61% believed that chronic pain trained specialist anaesthetists should be responsible; 92.7% of respondents agreed that patients who are educated about their pain tend to do better. Most importantly, 96.7% of respondents feel that they will benefit from more education regarding pain management in chronic pain patients. Conclusions: The majority of non-pain specialist anaesthetists recognise the importance of education regarding pain management for non-malignant chronic pain patients. Many feel that they are not confident in managing these patients and will benefit from continuing medical education and self-assessment courses to improve their confidence. These results could be used to enrich current pain management courses.

This article summarizes the treatment of an older adult with borderline personality disorder and a co-occurring opioid abuse using an integration of the recovery model, person-centered therapy, and the stages of change. Therapy included rapport building, a nonjudgmental attitude, enhancing understanding of behaviors that interfere with the client’s goals, clarifying consequences of the client’s choices, empathizing with the client’s fear of reducing opioid use, building coping skills, and providing a strong, supportive presence through the opiate reduction process. Over the course of treatment, the client’s overuse of opioids decreased as did her depression and suicidal ideation. This case highlights the importance of understanding medication abuse from the client’s perspective, emphasizing nonjudgment and clarifying the client’s choices and the consequences of her choices.

Background:Canada leads in opioid prescription and consumption rates, and this has resulted in high levels of opioid-related morbidity and mortality. Pharmacists’ input could contribute significantly to understanding the disadvantages of opioid prescribing and dispensing and improving the service. This study aimed to examine the experiences of community pharmacists in relation to opioid prescribing and dispensing, with a focus on optimizing collaboration and communication.Methods:An online survey was performed among pharmacists from the province of Quebec, Canada, in 2016. Pharmacists were eligible if registered and working in community pharmacies.Results:In all, 542 questionnaires were analyzed (participation rate of 8.1%). Pharmacotherapy-related problems were reported in at least 50% of opioid prescriptions: additional drug(s) required (reported by 30% of pharmacists), interaction(s) between opioid(s) and other drug(s) (16%), physician did not meet the general issuing standards for opioid prescriptions (26%) and patient had mild to moderate pain that was easily managed by a nonopioid analgesic (20%). Half of the patients were reported as requesting anticipated refills, possibly indicating abuse or poor pain control. Most pharmacists (89.6%) reported needing to contact physicians in 1 to 3 out of 10 opioid prescriptions, but many pharmacists (71.8%, often or very often) reported difficulties communicating with physicians.Conclusions:Pharmacists’ observations of pharmacotherapy-related problems and patients’ unusual behaviours reveal a significant number of issues related to opioid prescribing and dispensing in an outpatient setting. Improved collaboration between physicians and pharmacists appears mandatory to address the issues reported in this study.

People with chronic noncancer pain who rely on prescription opioid painkillers for treatment experience stigmatization, both within and outside of the health care system, which hinders their ability to achieve adequate pain relief. This barrier to appropriate treatment affects not only individual patients but their families as well. In this article, I provide an autoethnographic account of my experience as the daughter of a mother with severe chronic pain who manages her condition with prescription opioid painkillers. Through personal narrative, I explore how I, and members of my family, experience and interpret barriers my mom faces in accessing effective treatment, and how even now, over a decade after my mom’s pain started, the stigma surrounding prescription opioids continues to permeate every facet of our lives.

Background Approximately 18% of US adolescents engaged in prescription opioid abuse in 2013. However, this estimate may be misleading because it includes both medical misusers and nonmedical users, and there is evidence that these are 2 groups that differ relative to substance abuse and criminal risk. Thus, this study does not combine medical and nonmedical users; rather, it seeks to better understand the characteristics of nonmedical users. Methods This was a school-based, cross-sectional study that was conducted during 2009–2010 in southeastern Michigan with a sample of 2627 adolescents using a Web-based survey. Three mutually exclusive groups were created based on responses regarding medical and nonmedical use of opioid analgesics. Group 1 had never used an opioid analgesic, Group 2 used an opioid analgesic only as prescribed, and Group 3 nonmedically used an opioid analgesic. In addition, Group 3 was divided into 2 mutually exclusive subgroups (self-treaters and sensation-seekers) based on reasons for nonmedical use. A series of multinomial logistic regressions were conducted to determine if the groups differed on the presence of pain, psychological symptoms (e.g., affective disorder, conduct disorder, attention-deficit/hyperactivity disorder [ADHD]), and drug abuse. Results Sixty-five percent (65.0%) of the sample was white/Caucasian and 29.5% was African American. The average age was 14.8 years (SD = 1.9). Seventy percent (70.4%; n = 1850) reported no lifetime opioid use, 24.5% ( n = 644) were medical users, 3.5% ( n = 92) were nonmedical users who used for pain relief only, and 1.6% ( n = 41) were classified as nonmedical users for reasons other than for pain relief (e.g., to get high). Both medical users and nonmedical users reported more pain and substance abuse symptoms compared with never users. Those nonmedical users who used opioids for sensation-seeking motivations had greater odds of having psychological symptoms. Conclusions These data support the need to further consider subgroups of nonmedical users of opioid analgesics.

Our objective was to explore the effectiveness of a palliative care team (PCT) by investigating potential differences in opioid prescription between patients who had had PCT involvement before admission to an inpatient hospice and those who had not. A total of 221 patients met the criteria; they were divided into an intervention group (n = 140) and a control group (n = 81). The daily dose of opioid before admission to the hospice was significantly higher in the intervention group ( P < .001). The difference between the maximum opioid dose and the initial dose, the rate of increase in opioids until death, and the length of stay in the hospice were not significantly different between the groups. A PCT contributes to more appropriate use of opioids before admission to a hospice.

Background: Prescription opioid (PO) abuse has reached epidemic proportions in the United States, and pharmacies are locations from which these medications are often diverted. This study identifies factors associated with pharmacists who currently screen and discuss PO misuse with patients. Methods: A secondary data analysis of a cross-sectional Web-based survey that was sent to pharmacists was conducted. The survey contained items that assessed whether pharmacists currently screened and discussed PO misuse with patients along with pharmacists’ attitudes and beliefs toward providing brief interventions. Multivariable models were developed which identified factors associated with pharmacists’ currently screening and discussing misuse. Results: Chain setting pharmacists (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 1.16-32.72) and pharmacists interested in being directly involved in PO screening and brief intervention research projects (OR = 2.06, 95% CI = 1.35-3.15) were most likely to report current screening. Pharmacists who reported currently screening for misuse (OR = 4.27, 95% CI = 2.83-6.45) and who reported wanting to help patients who misuse POs (OR = 3.03, 95% CI = 1.50-6.15) were most likely to currently discuss abuse. Conclusions: Investigators implementing pharmacy-based screening and brief intervention studies for POs should take into account practice location and pharmacists’ interest in addressing PO issues.

Background: In North Carolina, the Strengthen Opioid Misuse Prevention Act of 2017 (STOP Act) went into effect on January 1, 2018, intending to increase oversight over opioid prescriptions. This study compares postoperative narcotic prescription practices following operative fixation of ankle fractures before and after the STOP Act. Methods: This study was a retrospective review of patients 18 years and older who underwent operative fixation of ankle fractures between January 1 and June 30, 2017 (before STOP Act), and between January 1 and June 30, 2018 (after STOP Act). Variables of interest included demographics, amount of opioids prescribed postoperatively, number of prescription refills, and number of pain-related calls or visits to the emergency department (ED) or clinic after surgery. This study assessed 71 patients in the Pre group and 47 patients in the Post group. Results: There was a statistically significant decrease in the average number of postoperative narcotic pills prescribed after the STOP Act (52.7 vs 76.2, P < .001). There was also a statistically significant decrease in the average number of prescription refills (0.6 vs 1.0, P = .037). There were no significant changes in pain-related clinic calls (35.2% Pre vs 34.0% Post, P = .896), pain-related clinic visits ahead of schedule (4.2% Pre vs 6.4% Post, P = .681), or pain-related ED visits (2.8% Pre vs 10.6% Post, P = .113). Conclusion: In the postoperative period after operative fixation of ankle fractures, the volume of narcotic prescriptions decreased after the new legislation, without an associated strain on medical resources. Level of Evidence: Level III, therapeutic, comparative study.

Background: Prescription opioid rates have been found to vary on a county and state level. We aim to find if significant hospital-level and regional-level variation in opioid prescription rates exists in a pediatric orthopedic setting. Methods: We conducted a retrospective cohort study of children ages 10-18 who sustained an ACL injury between 2012-2016, from 39 hospitals throughout the United States, found through the Pediatric Health Information System. Patients were divided into four regions according to the regional census of hospital admission, and demographics were recorded. Primary outcomes were hospital-level variation in opioid prescription rates using a mixed effects linear regression model to compare mean differences in average opioid prescription rate. Results: 11,452 pediatric patients were analyzed for regional-level variation in opioid prescription rates. Of those patients 7,879 were analyzed for hospital-level variation in opioid prescription rates based on if the hospital of incidence had a sample size of at least 250 patients over the five-year span (16 of the 43 hospitals fit this criteria). The most common demographics were patients ages 16-18 (n=5,613; 49.01%), white (n=6,588; 57.53%), and male (n=5,905; 51.56%). The 11,452 patients were divided into four regions: (1) Northeast (n=2,409; 21.04%), (2) Midwest (n=2,499; 21.82%), (3) South (n=3,869; 33.78%), and (4) West (n=2,675; 23.36%). After adjustment, significant variation in opioid prescription rates was found to exist at both a hospital-level using a random intercept and random slope model (-2LL=17882.381, pConclusions: Significant variation of opioid prescription rates exists at both a hospital-level and a regional-level over the last five years in a pediatric orthopedic setting. The findings of this study build off previous findings from the Centers for Disease Control, which found significant variation existed in opioid prescription rates on a state-wide level. Given the recent guidelines proposed by the CDC to control and limit prescription opioids (as of March 2016), future studies finding the impact of the guidelines on variation of prescription rates in a pediatric orthopedic setting could be beneficial. [Table: see text][Figure: see text]

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

Background: Managing postoperative pain in hand surgery is important for both patients and surgeons. However, there is growing concern over prescription opioid abuse. We hypothesized: (1) that pain medications after carpal tunnel release (CTR) surgery are over-prescribed; and (2) that opioids are unnecessary in the majority of patients. Methods: We prospectively studied 2 demographically similar patient cohorts receiving either opioid or tramadol for CTR performed by 2 hand surgery fellowship-trained orthopedic surgeons over a 1-year period. The first cohort of patients undergoing CTR received opioids pills postoperatively. The second cohort of patients received a standard prescription of 10 tramadol pills postoperatively. Student t tests were performed to evaluate statistically significant differences between the tramadol and opioid cohorts in total pill consumption and number of postoperative days the medication was used. Results: The opioid cohort consisted of 159 patients with a mean opioid consumption of 4.9 pills for 2.3 days. Eleven of these patients declined the use of opioids postoperatively and instead substituted for nonsteroidal anti-inflammatories and/or acetaminophen. The tramadol cohort consisted of 110 patients with a mean tramadol consumption of 3.3 pills for 1.8 days. Seven of these patients requested opioids postoperatively, and 14 substituted for nonsteroidal anti-inflammatory drugs and/or acetaminophen. When comparing the postoperative consumption of opioids and tramadol for CTR, there was a statistically significant difference in total pill consumption based on both intention to treat as well as the medication ultimately prescribed. There was no difference in the duration of postoperative utilization. Conclusion: Following CTR, pain medications are being over-prescribed, with patients receiving more than double the amount of pills than they consume. Tramadol appears to be equally effective in managing postoperative pain compared with opioids.

Modern desistance research has examined many facets of desistance, in terms of theoretical predictors of desistance and recidivism, and in terms of differing types of offending. Though predicting desistance from illegal drug use is among these topics, no research to date has examined the predictors of desisting from prescription opioid abuse. This study uses longitudinal data from 318 prescription opioid users to analyze the effects of various predictors of desistance on declining nonmedical prescription opioid use, with an emphasis on gender differences among participants. Results indicate that theoretical and demographic characteristics correspond with differing rates of decline and further vary by gender.

In 2016, the Centers for Disease Control and Prevention (CDC) issued the first national guideline in the United States regarding opioid prescribing for pain.1 The guideline included the recommendat...

Objective: To assess the prevalence of nonmedical prescription opioid use (NMPOU) in the Canadian general adult population in the context of rising overall prescription opioid (PO) consumption and related problems in North America. Method: The prevalence of NMPOU was assessed as a multiitem construct in the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS; n = 16 672), an ongoing cross-sectional monthly random digit dialing telephone survey representative of the general Canadian population, aged 15 years and older. CADUMS data were collected between April and December of 2008 with a response rate of 43.5%. Results: About 22% of CADUMS respondents reported PO use in the last year, while 0.5% reported NMPOU during the same time frame. PO use was significantly higher among women than among men, and highest in the group aged 25 to 54 years. NMPOU was similar among men and women, and highest in the group aged 15 to 24 years. Conclusions: CADUMS data indicate an extremely low rate of NMPOU, especially given the levels of overall PO use, other PO-use related problems, and NMPOU levels estimated in the general US population where NMPOU has been assessed to be 10 times higher than in Canada. NMPOU survey item construction and response rates appear to strongly influence and potentially compromise NMPOU survey data. Existing NMPOU data and survey methods need to be validated for this important indicator in Canada, where increasing PO use and problem levels have been recognized as a significant and rising public health problem.

Recent North American data suggest that the misuse of prescription opioids (POs) has substantially increased in segments of the general population (e.g., adults, youth, students), as well as in specific high-risk groups (e.g. street drug users), in many instances surpassing prevalence rates for traditional illicit drugs. Some 11 million U.S. citizens are estimated to have misused POs in 2002 alone. These misuse trends have corresponded with increases in PO-related harms, i.e. morbidity (e.g., emergency room mentions) and mortality (e.g., poisoning deaths). Existing data suggest that POs for misuse are obtained from a diverse variety of sourcing routes, many of which involve direct or indirect diversion from the medical system, yet also include personal contacts, thefts or street markets. The above is occurring in a recent context of massively increased medical availability and use of POs, mainly due to changes in pain treatment practice, with North America being the world's top PO consumer region. The intersecting of legitimate and illegitimate PO use poses enormous challenges for devising control interventions that effectively address the problem of PO misuse while not compromising adequate pain care. Current interventions include intensified PO availability regulation by prescription monitoring programs (PMPs). This article reviews available (mainly North American) data describing the phenomenon of PO misuse, while considering policy implications.

Background: Lomotil (diphenoxylate atropine combination) has been in use as an antidiarrhoeal agent. Due to presence of opioid (diphenoxylate), there are chances of abuse. The reports of abuse of lomotil have been few in published literature. This chart review aimed to evaluate the characteristics of patients with dependence on lomotil coming to our centre. Materials and Methods: This retrospective chart review was conducted at the Drug De-addiction and Treatment Centre of PGIMER, Chandigarh, India. The records of patients who had presented to the centre with dependence on Lomotil in the last five years were identified, and clinical details were extracted from the records. Results: We identified 41 patients who had presented to our centre with dependence upon lomotil as the primary substance of abuse. The cases were typically married and employed males, educated up to 10 th grade, belonging to a rural Sikh extended or joint family. Most of the patients had taken other opioids too. The number of tablets taken in a day varied from 3- to 250 (median 25). The reasons of initiation were to relieve withdrawals, as a cheap substitute opioid, curiosity, and on suggestion of friends. Conclusion: Lomotil is a medication with a potential of abuse and regulatory controls are required to prevent escalation of misuse of this easily available prescription drug. Lomotil (diphenoxylate and atropine combination) has been used since a long time as an anti-diarrheal agent. Reports of abuse of diphenoxylate had surfaced. We present a series of 41 cases of opioid dependence presenting with the use of the diphenoxylate as the primary substance. The cases were typically married and employed males, educated up to 10 th grade, belonging to a rural Sikh extended or joint family. Most of the patients had taken other opioids too. The number of tablets taken in a day varied from 3 to 250 (median 25). The reasons of initiation of diphenoxylate were to relieve withdrawals, as a cheap substitute opioid, curiosity, and suggestion of friends. Regulatory controls are needed to prevent escalation of use of this easily available prescription opioid.

Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs) on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database) and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set) in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group) for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001). PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063). A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785). Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.