Effects of Michigan Opioid Laws on Prescriber Practices in the Emergency Department

Research Mentor Name

Dr. Claire Pearson

Research Mentor Email Address


Institution / Department

Ascension St. John Hospital Emergency Department

Document Type

Research Abstract

Research Type


Level of Research



Introduction: Opiate analgesics (OA) are responsible for more overdose deaths than any other medication class. Michigan is among the states most greatly affected by the opioid epidemic, and in late 2017, the Michigan Opioid Laws were passed in efforts to decrease opioid associated addiction and overdose deaths. This set of laws provides regulation of OA prescriptions and to increase patient awareness of the associated risks of opioid use. These laws collectively require a physician to educate the patient on harms of opiates, provide substance abuse disorder services in the setting of an overdose, establish a relationship with the patient, obtain a Prescription Drug Monitoring Program (PDMP)[MS1] query for prescriptions greater than three days, and limit duration of opioid therapy for acute pain to seven days. This study assessed the effect of these laws on the prescribing patterns of providers at Ascension St. John’s Emergency Department (ED), which serves patients from Detroit and several surrounding cities.

Methods: A retrospective chart review was conducted of patients 18 years and older that received an opioid prescription from the ED at Ascension St. John Hospital during the six months immediately preceding and following the implementation of Michigan Opioid Laws. Exclusion criteria included pregnancy, and admission to the hospital. Patient data collected included gender, age, race, insurance status, ED visit frequency, and prescriptions written at discharge. Prescription data included the type of opioid, duration, dose, and morphine equivalents (MEqs). Primary outcomes were average duration of therapy and morphine equivalents prescribed. chi-squared analysis was used to compare the pre- and post- periods.

Results: A list of 8217 opioid prescriptions written during the study time-period was generated via a pharmacy query. From this list, a random sample of 200 patients from each time-period (pre-implementation and post-implementation) were selected. The median number of morphine equivalents prescribed was significantly lower in the post-period (60 (IQR: 43.5) vs 54 (IQR: 24), p<0.0001). During the post period, significantly more opioid prescriptions were written for two days or less (36.0% vs. 48.5%, p<0.001).

Conclusion: Given the reduction in total prescriptions, and significant reduction in median MEqs and duration of treatment, we found a significant change in provider prescribing patterns in Ascension St. John’s ED following the implementation of the Michigan Opioid laws.


Clinical Epidemiology | Community Health and Preventive Medicine | Medicine and Health Sciences | Other Public Health

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