Hospital best practices linked to modest changes in prescription opioid dispensing

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Emergency room entrance with ambulance
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In 2012, Washington state mandated seven hospital best practice strategies in an effort to reduce the number of preventable Medicaid emergency department (ED) visits and redirect care to the most appropriate setting. Some of these mandates were thought to affect ED opioid prescribing and provide a template for other states to use when addressing the opioid overdose crisis. The authors of this study assessed whether the Washington state hospital mandates had any impact on Medicaid beneficiary opioid dispensing rates after an ED visit.

The mandates included health information exchange among hospitals so that providers in the ED have information about each patient’s prior use of ED services in the past 12 months, the use of the prescription drug monitoring program database, efforts to connect frequent users of the ED with primary care, and prescribing guidelines for ED providers.

Over 266,000 ED Medicaid fee-for-service beneficiary visits in Washington state from July 1, 2011 to June 30, 2013, were analyzed using a retrospective, observational analysis. This timeframe allowed the authors to observe opioid prescribing 12 months preceding and following the mandates.

The authors conclude that hospital best practice mandates were associated with small reductions in opioid dispensing following an ED visit. The effect size was not larger for patients with prior risk or chronic opioid use, indicating that additional work is needed to reduce opioid prescribing to these patients.