Using Default Opioid Prescription Settings to Limit Excessive Opioid Prescribing to Adolescents and Young Adults

Project start date and end date: 2019 - 2024

Background:

Prescription opioid use by adolescents and young adults aged 12-25 years increases their risk of prescription opioid misuse. Adolescents and young adults collectively have the highest rates of prescription opioid misuse of any age group, and leftover opioids from prior prescriptions are a key driver of this misuse. As such, it is crucial to ensure that quantities in opioid prescriptions match the needs of adolescents and young adults.

Currently, efforts to limit excessive opioid prescribing largely focus on regulations by states and insurers that bluntly restrict quantities in opioid prescriptions to arbitrary limits such as a seven-day supply. Though well-intentioned, these regulations do not account for heterogeneity in patient need, are not evidence-based, and infringe upon provider autonomy, potentially decreasing provider support. An alternative approach that may overcome these drawbacks is to estimate patient need empirically by collecting data on opioid consumption, then implement behavioral interventions to “nudge” providers towards prescribing that matches the needs of most patients, while still allowing providers to prescribe higher or lower quantities to individual patients when indicated. To date, behavioral interventions informed by patient opioid consumption patterns have not been implemented to promote appropriate opioid prescribing to adolescents and young adults.

Objectives:

• Aim 1. To pilot a behavioral intervention using default opioid prescription settings among adolescents and young adults undergoing tonsillectomy and/or adenoidectomy at the University of Michigan.
• Aim 2: To refine the intervention for future research by assessing providers’ experiences with the default settings.
• Aim 3: To identify additional high-priority procedures and conditions for default setting interventions.

Research Topics & Methods:

This proposal will pilot an electronic health record-based intervention using default opioid prescription settings to limit excessive opioid prescribing to adolescents and young adults undergoing tonsillectomy, a common surgery associated with high rates and quantities of opioid prescribing. In the pilot study, the default settings will be informed by data on baseline patient-reported post-operative opioid consumption, thereby increasing the likelihood that these settings reflect patient need.

Implications:

Findings from this proposal will determine the intended and unintended effects of a low-cost behavioral nudge on opioid prescribing after tonsillectomy among adolescents and young adults, as well as the feasibility of implementing such an intervention in other institutions and procedures.

Funder:

This project is funded by the National Institute on Drug Abuse.

Collaborators:

Chad Brummett (Co-I), Lisa Prosser (Co-I), Amy Bohnert (Co-I), Sean McCabe (Co-I), Gary Freed (Co-I)