The Effect of Online Prescription Drug Monitoring on Opioid Prescription Habits After Elective Single-level Lumbar Fusion

Introduction: The United States opioid epidemic is a well-documented crisis stemming from increased prescriptions of narcotics. Online prescription drug monitoring programs (PDMPs) are a potential resource to mitigate narcotic misuse by tracking controlled substance prescriptions. Therefore, the purpose of this study was to evaluate opioid prescription trends after implementation of an online PDMP in patients who underwent single-level lumbar fusion. Methods: Patients who underwent a single-level lumbar fusion between August 27, 2017, and August 31, 2020, were identified and placed categorically into one of two cohorts: an "early adoption" cohort, September 1, 2017, to August 31, 2018, and a "late adoption" cohort, September 1, 2019, to August 31, 2020. This allowed for a 1-year washout period after Pennsylvania PDMP implementation on August 26, 2016. Opioid use data were obtained by searching for each patient in the state government's online PDMP and recording data from the year before and the year after the patient's procedure. Results: No significant difference was observed in preoperative opioid prescriptions between the early and late adoption cohorts. The late adoption group independently predicted decreased postoperative opioid prescriptions (beta, 0.78; 95% confidence interval [CI], 0.65 to 0.93; P = 0.007), opioid prescribers (beta, 0.81; 95% CI, 0.72 to 0.90; P < 0.001), pharmacies used (beta, 0.90; 95% CI, 0.83 to 0.97; P = 0.006), opioid pills (beta, 0.61; 95% CI, 0.50 to 0.74; P < 0.001), days of opioid prescription (beta, 0.57; 95% CI, 0.45 to 0.72; P < 0.001), and morphine milligram equivalents prescribed (beta, 0.53; 95% CI, 0.43 to 0.66; P < 0.001). Conclusions: PDMP implementation was associated with decreased postoperative opioid prescription patterns but not preoperative opioid prescribing behaviors.