The 2024 Nudges in Health Care Symposium will take place September 26–27 in Philadelphia. Learn more and register

Default Options to Decrease Opioid Prescribing Durations

Default Options to Decrease Opioid Prescribing Durations

Project status



Jeanmarie Perrone, MD

Zachary Meisel MD, MSHP

Frances Shofer, PhD

Scott Halpern, MD, PhD

Christopher Edwards, MD

Innovation leads


National Institute on Drug Abuse

National Institute of Child Health and Human Development


Drug overdose is the leading cause of injury-related death in the United States, with 91 Americans dying daily from opioid-related overdoses.   

Prescribing behaviors have been shown to contribute to this epidemic. In fact, the duration of a patient’s first opioid prescription is directly related to their likelihood of developing an addiction to opioids in the future.


We worked with partners in Penn Medicine emergency departments (EDs) to explore if default settings in the electronic health record (EHR) could increase compliance with opioid prescribing guidelines.

The default for new ED discharge opioid prescription orders was set to ten. Providers who wanted to prescribe a larger amount were required to opt out of the 10-tablet prescription before selecting or manually entering a new amount.  


The implementation of this default resulted in fewer opioids prescribed to patients. The median number of opioid tablets per prescription decreased significantly, and the percentage of 10-tablet prescriptions more than doubled from 21 percent to 43 percent. 

The results of this pilot led Penn Medicine to implement the default setting across the health system.