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Decline in primary care providers’ prescribing of Schedule II opioids following the implementation of federal and state guidelines

Lisa B. E. Shields, MD, Timothy A. Johnson, BS, James P. Murphy, MD, Douglas J. Lorenz, PhD, Alisha Bell, MSN, RN, CPN, Kenneth C. Wilson, MD, Steven T. Hester, MD, MBA, Joshua T. Honaker, MD, MBA, FAAP


Objective: Prescription opioid misuse represents a social and economic dilemma in the United States. The authors evaluated primary care providers’ (PCPs) prescribing of Schedule II opioids at our institution in Kentucky.

Design: Prospective evaluation of PCPs’ prescribing practices over a 3-year period (October 1, 2014 to September 30, 2017) in an outpatient setting.

Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards. Special attention focused on Schedule II opioid prescriptions with a quantity > 90, Opana/ Oxycontin, and morphine equivalent daily dosage.

Results: A statistically significant increase in the total number of PCPs and PCPs who prescribed Schedule II opioids was observed, while there was a concurrent significant decrease in the average number of Schedule II opioid pills prescribed per PCP, Schedule II opioid prescriptions per PCP, Schedule II opioid pills prescribed per patient by PCPs, Schedule II opioid prescriptions with a quantity > 90 per PCP, and Opana/Oxycontin prescriptions per PCP. A statistically significant decline in the average morphine equivalent daily dosage of Schedule II opioids per PCP was noted.

Conclusions: This study reports the benefit of incorporating federal and state regulations and institutional evidence-based guidelines into primary care practice to decrease the number of Schedule II opioids prescribed. Further preventive measures include selecting alternative treatments to opioids and reducing the rates of opioid nonmedical use and overdose while maintaining access to prescription opioids when indicated.


opioids, primary care providers, prescription drugs, prescribing practices, overdose, heroin, morphine equivalent daily dosage, addiction

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