Midcoast Maine Prescription Opioid Reduction Program

Prescription guidelines adopted by Maine hospital emergency departments help to reduce opioid prescriptions and dental pain emergency department visits

Starting in 2011, the Midcoast Maine Prescription Opioid Reduction Program sought to address the high rate of opioid prescriptions by adopting prescribing guidelines in two hospital emergency rooms.

This one page guideline is used when a patient is suspected of seeking opioids for non-medical use from an emergency department physician or nurse.

Practitioners are encouraged to check the patient's medical records and prescription history in the state's PDMP database. Provisions allow practitioners to deny issuing medications or refills, and if evidence suggests the patient is engaged in deception the practitioner may contact police.

A peer-reviewed evaluation found that the implementation of the guideline was associated with decreases in opioid prescriptions and ED visits for dental pain.

A performance improvement program...associated with a reduction in the rate of opioid prescriptions and visits for ED patients presenting with dental pain. 

Continuum of Care
Type of Evidence
Response Approach
Cautious Opioid Prescribing
Peer-reviewed Article

Evidence of Program Effectiveness

"Before the guideline, the rate of opioid prescription was 59% (302/515). After implementation, the rate was 42% (65/153). The absolute decrease in rates was 17% (95% confidence interval 7% to 25%). Additionally, in comparing the 12-month period before and after implementation, the dental pain visit rate decreased from 26 to 21 per 1,000 ED visits (95% confidence interval of decrease 2 to 9 visits/1,000)." (Fox et al., 2013)