Prescriptions for schedule II opioids and benzodiazepines increase after the introduction of computer-generated prescriptions.
BACKGROUND
Prescriptions for controlled substances decrease when regulatory barriers are put in place. The converse has not been studied.


OBJECTIVE
The objective was to determine whether a less complicated prescription writing process is associated with a change in the prescribing patterns of controlled substances in the emergency department (ED).


METHODS
The authors conducted a retrospective nonconcurrent cohort study of all patients seen in an adult ED between April 19, 2005, and April 18, 2007, who were discharged with a prescription. Prior to April 19, 2006, a specialized prescription form stored in a locked cabinet was obtained from the nursing staff to write a prescription for benzodiazepines or Schedule II opioids. After April 19, 2006, New York State mandated that all prescriptions, regardless of schedule classification, be generated on a specialized bar-coded prescription form. The main outcome of the study was to compare the proportion of Schedule III-V opioids to Schedule II opioids and benzodiazepines prescribed in the ED before and after the introduction of a less cumbersome prescription writing process.


RESULTS
Of the 26,638 charts reviewed, 2.1% of the total number of prescriptions generated were for a Schedule II controlled opioid before the new system was implemented compared to 13.6% after (odds ratio [OR] = 7.3, 95% confidence interval [CI] = 6.4 to 8.4). The corresponding percentages for Schedule III-V opioids were 29.9% to 18.1% (OR = 0.52, 95% CI = 0.49 to 0.55) and for benzodiazepines 1.4% to 3.9% (OR = 2.8, 95% CI = 2.4 to 3.4).


CONCLUSIONS
Patients were more likely to receive a prescription for a Schedule II opioid or a benzodiazepine after a more streamlined computer-generated prescription writing process was introduced in this ED.
McGerald
Genevieve
G
Department of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY, USA. genmcger2000@yahoo.com
Dvorkin
Ronald
R
Levy
David
D
Lovell-Rose
Stephanie
S
Sharma
Adhi
A
D000328:Adult; D000701:Analgesics, Opioid / Q000145:classification / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D015331:Cohort Studies; D016001:Confidence Intervals; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004335:Drug and Narcotic Control; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009518:New York; D010098:Oxycodone / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D001569:Benzodiazepines; D006853:Hydrocodone; D010098:Oxycodone