Clinical Effectiveness of Decision Support for Prescribing Opioids for Chronic Noncancer Pain: A Prospective Cohort Study
Open accessAbstract
Objectives This prospective cohort study examines the clinical effectiveness of electronic medical record clinical decision support (EMR CDS) for opioid prescribing.Methods Data analysis included primary care patients with chronic opioid therapy for noncancer pain seen within an integrated health delivery system in Louisiana between January 2017 and October 2018. EMR CDS incorporated an opioid health maintenance tool to display the status of risk mitigation, and the medication order embedded the morphine equivalent daily dose (MEDD) calculator and a hyperlink to the Louisiana pharmacy drug monitoring program. Outcome measures included change in the average MEDD and rates of opioid risk mitigation, hospitalization, and emergency department use.Results Among 14 221 patients, 9% had prescriptions with an average MEDD ≥90 mg. There were no significant changes in MEDD after EMR CDS implementation. Increasing age, Charlson Comorbidity Index score, female sex, black non-Hispanic race, non-opioid pain medication co-prescriptions, and specialty referrals were associated with a lower odds of MEDD ≥90 (high-dose threshold). Medicare or self-pay, substance abuse history, and pain agreements were associated with increased odds of prescribing above this high-dose threshold. After incorporation of EMR CDS, patients had higher rates of urine drug screens (17% vs 7%) and naloxone prescriptions (3% vs 1%, all P < .001). In addition, specialty referrals to physical or occupational therapy, orthopedics, neurology, and psychiatry or psychology increased in the postintervention period. Although emergency department use decreased (rate ratio 0.92; 95% confidence interval 0.89-0.95), hospitalization rates did not change.Conclusions EMR CDS improved adherence to opioid risk mitigation strategies. Further research examining which practice redesign interventions effectively reduce high-dose opioid prescribing is needed.
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In the authors' prior study of provider-targeted EMR-CDS for safe opioid prescribing, approximately 30% of patients receiving opioid therapy for chronic pain had documented histories of depression or anxiety.
“In the authors' prior study of a provider-targeted electronic medical record clinical decision support (EMR-CDS) for safe opioid prescribing, approximately 30% of patients receiving opioid therapy for chronic pain had documented histories of depression or anxiety. 11”
From Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial (2024) · cites this paper as [11]
The Discussion (page unavailable) says almost 30% of study patients had a known history of mental health conditions. The Results (page unavailable) describe the documented conditions as depression, anxiety, or substance abuse, so the paper does not establish that approximately 30% specifically had histories of depression or anxiety. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPrior studies have shown that neither opioid risk reduction tools nor cognitive behavioral therapy reduce the use of opioid medications.
“Prior studies have shown that neither opioid risk reduction tools nor cognitive behavioral therapy (CBT) will reduce the use of opioid medications.”
From Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial (2024) · cites this paper as [11]
The Results section (‘Change in High-Dose Opioid Prescribing’; page unavailable) reports no significant change in opioid dose categories or average prescribed dose after implementation of the electronic decision-support tool. This supports the claim for that tool, but the paper does not assess whether cognitive behavioral therapy reduces opioid medication use. Its finding about prescribing after one intervention also does not establish that risk-reduction tools generally will not reduce use. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPatients with a history of substance abuse, depression, or anxiety had higher odds of receiving opioid prescriptions with a morphine equivalent daily dose (MEDD) ≥90 mg.
“we previously reported in an observational study that patients with a history of substance abuse, depression, or anxiety had higher odds of receiving opioid prescriptions with a morphine equivalent daily dose (MEDD) ≥90 mg. 11”
In the authors' prior study of EMR-CDS implementation, only marginal increases were observed in urine drug screens, naloxone prescriptions, specialty referrals, and screening for depression or anxiety.
“we observed only marginal increases in urine drug screens, naloxone prescriptions, specialty referrals, and screening for depression or anxiety.”
In the authors' prior study of the EMR-CDS, the opioid risk mitigation tool did not change average MEDD of opioid prescriptions.
“The authors' prior study of the EMR-CDS revealed that the opioid risk mitigation tool did not change average MEDD of opioid prescriptions.”
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Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
An Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ–4
Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2009) · Psychosomatics · doi:10.1016/s0033-3182(09)70864-3 · Cited by 4,261 · see citing works
Validation of the Brief Pain Inventory for chronic nonmalignant pain
Tan, G., Jensen, M. P., Thornby, J. I., & Shanti, B. F. (2004) · The Journal of Pain · doi:10.1016/j.jpain.2003.12.005 · Cited by 1,416 · cited 1× · see citing works
“An opioid management tool also provides quick links to the PEG (Pain, Enjoyment, General Activity) 3-Item Pain Scale;[13,14] PHQ-4, PHQ-9 and GAD-7 [15–17].”
MethodWebster, L. R., & Webster, R. M. (2005) · Pain Medicine · doi:10.1111/j.1526-4637.2005.00072.x · Cited by 1,096 · see citing works
Barriers and Strategies in Guideline Implementation—A Scoping Review
Fischer, F., Lange, K., Klose, K., Greiner, W., & Kraemer, A. (2016) · Healthcare · doi:10.3390/healthcare4030036 · Cited by 903 · see citing works
Kochanek, K. D., Murphy, S. L., Xu, J., & Arias, E. (2019) · PubMed · Cited by 454 · see citing works
ASIPP, A. (2012) · Pain Physician · doi:10.36076/ppj.2012/15/s67 · Cited by 426 · see citing works
King, N., Fraser, V., Boikos, C., Richardson, R. A., & Harper, S. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.301966 · Cited by 287 · see citing works
Manchikanti, L., Abdi, S., Atluri, S. L., Balog, C. C., Benyamin, R. M., Boswell, M. V., Brown, K. R., Bruel, B. M., Bryce, D. A., Burks, P. A., et al. (2012) · PubMed · Cited by 243 · see citing works
Xu, J., Murphy, S. L., Kochanek, K. D., Bastian, B. A., & Arias, E. (2018) · PubMed · Cited by 229 · see citing works
Schieber, L., Guy, G., Seth, P., Young, R., Mattson, C., Mikosz, C. A., & Schieber, R. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.0665 · Cited by 225 · see citing works
Meyer, R., Patel, A. M., Rattana, S. K., Quock, T. P., & Mody, S. H. (2014) · Population Health Management · doi:10.1089/pop.2013.0098 · Cited by 184 · see citing works
Vital Signs: Pharmacy-Based Naloxone Dispensing — United States, 2012–2018
Guy, G. P., Haegerich, T. M., Evans, M. E., Losby, J. L., Young, R., & Jones, C. M. (2019) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6831e1 · Cited by 180 · see citing works
Jamison, R. N., Sheehan, K. A., Scanlan, E., Matthews, M. L., & Ross, E. L. (2014) · Journal of Opioid Management · doi:10.5055/jom.2014.0234 · Cited by 172 · see citing works
Self-citationKrebs, E. E., Bair, M. J., Damush, T. M., Tu, W., Wu, J., & Kroenke, K. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181eaf835 · Cited by 162 · see citing works
Martel, M. O., Wasan, A. D., Jamison, R. N., & Edwards, R. R. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.02.034 · Cited by 139 · see citing works
Self-citationWasan, A. D., Michna, E., Edwards, R. R., Katz, J. N., Nedeljković, S. S., Dolman, A. J., Janfaza, D. R., Isaac, Z., & Jamison, R. N. (2015) · Anesthesiology · doi:10.1097/aln.0000000000000768 · Cited by 134 · see citing works
Self-citationOpioids, Chronic Pain, and Addiction in Primary Care
Barry, D. T., Irwin, K. S., Jones, E. S., Becker, W. C., Tetrault, J. M., Sullivan, L. E., Hansen, H., O’Connor, P. G., Schottenfeld, R. S., & Fiellin, D. A. (2010) · Journal of Pain · doi:10.1016/j.jpain.2010.04.002 · Cited by 120 · see citing works
Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse
Edwards, R. R., Wasan, A. D., Michna, E., Greenbaum, S., Ross, E. L., & Jamison, R. N. (2011) · Journal of Pain · doi:10.1016/j.jpain.2011.02.357 · Cited by 109 · see citing works
Self-citationChronic Opioid Therapy for Chronic Non-Cancer Pain: A Review and Comparison of Treatment Guidelines
Cheung, C.-W. (2014) · Pain Physician · doi:10.36076/ppj.2014/17/401 · Cited by 87 · see citing works
Prevention of Opioid Abuse in Chronic NonCancer Pain: An Algorithmic, Evidence Based Approach
Atluri, S. L. (2012) · Pain Physician · doi:10.36076/ppj.2012/15/es177 · Cited by 62 · see citing works
Using the CDC Guideline and Tools for Opioid Prescribing in Patients with Chronic Pain.
Dowell, D., & Haegerich, T. M. (2016) · PubMed · Cited by 42 · see citing works
Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines.
Cheung, C. W., Qiu, Q., Choi, S. W., Moore, B., Goucke, R. C., & Irwin, M. G. (2014) · PubMed · Cited by 39 · see citing works
(2018) · PubMed Central · Cited by 14 · see citing works
Self-citationReducing Opioid Prescribing Rates in Emergency Medicine.
Guarisco, J. S., & Salup, A. (2018) · PubMed Central · Cited by 12 · see citing works
Flagged first, then by citations
2 of the 28 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Atkins, N., & Mukhida, K. (2022) · Canadian journal of pain = Revue canadienne de la douleur · doi:10.1080/24740527.2022.2104699 · Cited by 62 · see citing works
Overstreet, D. S., Pester, B., Wilson, J. M., Flowers, K. M., Kline, N. K., & Meints, S. M. (2022) · Current Pain and Headache Reports · doi:10.1007/s11916-022-01098-8 · Cited by 48 · see citing works
Race, pain, and opioids among patients with chronic pain in a safety-net health system
Haq, N., McMahan, V., Torres, A., Santos, G., Knight, K. R., Kushel, M., & Coffin, P. O. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108671 · Cited by 35 · see citing works
Stipelman, C. H., Kukhareva, P., Trepman, E., Nguyen, Q., Valdez, L., Kenost, C., Hightower, M., & Kawamoto, K. (2022) · Yearbook of Medical Informatics · doi:10.1055/s-0042-1742518 · Cited by 26 · see citing works
Darnall, B. D., Edwards, K. A., Courtney, R. E., Ziadni, M. S., Simons, L. E., & Harrison, L. E. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1223172 · Cited by 21 · see citing works
Goudman, L., Smedt, A. D., Forget, P., Eldabe, S. S., & Moens, M. (2021) · Neuromodulation Technology at the Neural Interface · doi:10.1111/ner.13363 · Cited by 15 · see citing works
Pierce, R., Eskridge, B. R., Ross, B., Wright, M., & Selva, T. J. (2022) · Applied Clinical Informatics · doi:10.1055/s-0042-1745830 · Cited by 13 · see citing works
Johnson, D. G., Ho, V. T., Hah, J. M., Humphreys, K. N., Carroll, I. R., Curtin, C. M., Asch, S. M., & Hernandez‐Boussard, T. (2022) · PLOS Digital Health · doi:10.1371/journal.pdig.0000075 · Cited by 9 · see citing works
Cuadros, P., McCord, E., McDonnell, C., Apathy, N. C., Sanner, L. M., Adams, M. C. B., Mamlin, B. W., Vest, J. R., Hurley, R. W., Harle, C. A., et al. (2024) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2024.105649 · Cited by 7 · see citing works
McCartney, H., Main, A., Weir, N., Kaur, H., Ibrar, M., & Maguire, R. (2025) · Journal of Medical Internet Research · doi:10.2196/66457 · Cited by 8 · see citing works
Corriere, M. A., Dickson, A. L., Daniel, L. L., Nepal, P., Hall, K., Plummer, W. D., Dupont, W. D., Murray, K. T., Stein, C., Ray, W. A., et al. (2023) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001105 · Cited by 7 · see citing works
Price‐Haywood, E. G., Burton, J. H., Harden-Barrios, J., Bazzano, A. N., Lefante, J. J., Shi, L., & Jamison, R. N. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106250 · Cited by 7 · see citing works
Self-citationSystematic Review on Opioid Treatments for Chronic Pain: Surveillance Report 1
Chou, R., Selph, S., Wagner, J., Ahmed, A. Y., Jungbauer, R. M., Mauer, K., & Shetty, K. D. (2022) · doi:10.23970/ahrqepcsurveillanceopioidchronic · Cited by 6 · see citing works
Mazurenko, O., McCord, E., McDonnell, C., Apathy, N. C., Sanner, L. M., Adams, M. C. B., Mamlin, B. W., Vest, J. R., Hurley, R. W., & Harle, C. A. (2023) · JAMIA Open · doi:10.1093/jamiaopen/ooad063 · Cited by 6 · see citing works
System-wide opioid prescription reduction after shoulder arthroplasty
Navarro, R. A., Lin, C. C., Prentice, H. A., Alfaro, D. O., Burfeind, W. E., & Singh, A. (2021) · Seminars in Arthroplasty JSES · doi:10.1053/j.sart.2021.12.001 · Cited by 5 · see citing works
Siaton, B. C., Hogans, B. B., Frey‐Law, L., Brown, L. M., Herndon, C. M., & Buenaver, L. F. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2024.1254792 · Cited by 6 · see citing works
Situational Awareness of Opioid Consumption: The Missing Link to Reducing Dependence After Surgery?
Engelman, D. T., Crisafi, C., Hodle, T., Stiles, J., Nathanson, B. H., Zarbock, A., & Grant, M. C. (2022) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000005923 · Cited by 5 · see citing works
Wally, M. K., Thompson, M. E., Odum, S. M., Kazemi, D. M., Hsu, J. R., Seymour, R. B., & and PRIMUM Group (2023) · Applied Clinical Informatics · doi:10.1055/s-0043-1776879 · Cited by 4 · see citing works
Kusumadewi, S., & Miladiyah, I. (2023) · Indonesian Journal of Electrical Engineering and Computer Science · doi:10.11591/ijeecs.v30.i3.pp1748-1761 · Cited by 3 · see citing works
Systematic Review on Opioid Treatments for Chronic Pain: Surveillance Report 3
Chou, R., Selph, S., Wagner, J., Ahmed, A. Y., Jungbauer, R. M., Mauer, K., Shetty, K. D., Yu, Y., & Fu, R. (2022) · doi:10.23970/ahrqepcsurveillance3opioidchronic · Cited by 3 · see citing works
Price-Haywood, E. G., Burton, J. H., Harden-Barrios, J., Bazzano, A., Shi, L., Lefante, J., & Jamison, R. N. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-08965-7 · Cited by 2 · see citing works
Self-citationMazurenko, O., Apathy, N. C., Sanner, L. M., McCord, E., Adams, M. C. B., Hurley, R. W., Grout, R. W., Mamlin, B. W., Erazo, S. F., Blackburn, J. L., et al. (2025) · Applied Clinical Informatics · doi:10.1055/a-2639-4974 · Cited by 2 · see citing works
Gorbaty, J. D., Wally, M. K., Odum, S. M., Yu, Z., Hamid, N., Hsu, J. R., Beuhler, M. C., Bosse, M. J., Gibbs, M. A., Griggs, C. A., et al. (2023) · Journal of Opioid Management · doi:10.5055/jom.0834 · Cited by 2 · see citing works
Bart, G. B., Borgert-Spaniol, C. M., Crain, A. L., Haapala, J. L., Pj, O., Hooker, S. A., Solberg, L. I., Miley, K. M., Wright, E. A., Tusing, L. D., et al. (2026) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2026.209941 · Cited by 1 · see citing works
High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids
Sharif, L., Gunaseelan, V., Lagisetty, P., Bicket, M. C., Waljee, J. F., Englesbe, M. J., & Brummett, C. M. (2023) · Annals of Surgery · doi:10.1097/sla.0000000000005938 · Cited by 1 · see citing works
Comprehensive Approach to Opioid Management in a Primary Care Network
Fortuna, R. J., Venci, J. V., Johnson, W., Clark, J. S., Schlagman, S., Vandermark, K., Stetzer, A., Nasra, G. S., Martin-Stancil-El, S., & Judge, S. R. (2024) · Population Health Management · doi:10.1089/pop.2023.0234 · Cited by 1 · see citing works
Hohmann, L. A., Diggs, K., Valle-Ramos, G., Richardson, J., Phillippe, H. M., Correia, C. J., Marlowe, K. F., & Fox, B. I. (2024) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2024.100503 · Cited by 1 · see citing works
Systematic Review on Opioid Treatments for Chronic Pain: Surveillance Report 2
Chou, R., Selph, S., Wagner, J., Ahmed, A. Y., Jungbauer, R. M., Mauer, K., & Shetty, K. D. (2022) · doi:10.23970/ahrqepcsurveillance2opioidchronic · Cited by 1 · see citing works
Pain education research: Advances, innovations, and challenges
(2024) · Frontiers research topics · doi:10.3389/978-2-8325-4792-2
Integrating Nonpharmacological Options Into Perioperative Pain Care
Cheville, A. L., Herrin, J. S., Minteer, S. A., Grzegorczyk, V., Tilburt, J., Abdel, M., Basford, J., Cima, R., Cutshall, S., Courtright-Lim, A., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.35900
- Authors
- Price-Haywood, E. G., Burton, J., Burstain, T., Harden-Barrios, J., Lefante, J., Shi, L., Jamison, R. N., Bazzano, A., & Bazzano, L.
- Affiliations
- Ochsner Health System (US)
- Tulane University (US)
- Brigham and Women's Hospital (US)
- Venue
- Value in Health
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 23
- Issue
- 2
- Pages
- 157-163
- ISSN
- 1098-3015 (ISSN-L)
- PMC
- PMC7061936
- OpenAlex
- W2990104923
- Cited by
- 30
- References
- 28
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 7 · 2022: 9 · 2021: 3 · 2020: 1
- FWCI
- 2.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Value in Health (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid prescribing, chronic non-cancer pain, morphine equivalent daily dose, urine drug testing, emergency department utilization, hospitalization, specialist referral, primary care
- MeSH terms
- Clinical Decision-Making, Adult, Aged, Analgesics, Opioid, Decision Support Techniques, Female, Humans, Louisiana, Male, Middle Aged, Opioid-Related Disorders, Pain Measurement, Practice Patterns, Physicians', Drug Prescriptions, Primary Health Care, Prospective Studies, Risk Factors, Risk Assessment, Patient Selection, Decision Support Systems, Clinical, Comparative Effectiveness Research, Electronic Health Records, Chronic Pain
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