Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational studyBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.l6968 (Published 29 January 2020) Cite this as: BMJ 2020;368:l6968
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The study conducted by Kiang et al. rightfully concludes that interventions such as improving patient care and comorbidities can improve the opioid epidemic.  However, a recent randomized quality improvement study describes that the default number of pills on electronic prescriptions impacts the number of pills that are prescribed.  This forms the basis of an association between changing default electronic medical record settings and its influence on opioid prescribing behavior.
Most EMR systems are said to provide default prescriptions for opioids. The study was conducted at two emergency departments for a series of five 4-week blocks. During this time the prepopulated dispense quantities of discharge prescriptions were randomly altered every 4 weeks. Every 4 weeks for 20 weeks, each ED was randomly assigned a default prescription quantity of 5, 10, 15, or none specified. During this period, a total of 4320 opioid prescriptions were written by 104 ED physicians. Most prescriptions accounted for hydrocodone 5 mg/acetaminophen 325 mg.  The results revealed that for every 1 extra pill in the default prescription, 0.19 additional pills (95% CI, 0.15-0.22) were prescribed.  This was obtained using linear regression. Furthermore, on an evaluation of the 15 pairwise comparisons of default quantities, a lower default was associated with a lower number of pills prescribed. 
These findings suggest that the quantity of opioids prescribed is influenced by default settings in the EMR systems. Lowering the default quantities in the electronic order entry system can result in smaller quantities of opioid prescriptions. These outcomes also indicate that a low cost easily implementable EMR intervention can be used to combat the opioid epidemic.
1. Kiang Mathew V, Humphreys Keith, Cullen Mark R, Basu Sanjay. Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study BMJ 2020; 368 :l6968
2.. Montoy JCC, Coralic Z, Herring AA, Clattenburg EJ, Raven MC. Association of Default Electronic Medical Record Settings With Health Care Professional Patterns of Opioid Prescribing in Emergency Departments: A Randomized Quality Improvement Study. JAMA Intern Med. Published online January 21, 2020. DOI:10.1001/jamainternmed.2019.6544
Competing interests: No competing interests