Opioid Prescribing Reduced by 50% After Some Surgeries
/By Pat Anson, PNN Editor
In recent years, hospitals around the country have adopted policies to reduce the use of opioids for post-operative pain, fueled in part by studies showing that many surgery patients were sent home with more pills than they need. New research shows just how far efforts to reduce “overprescribing” have gone.
In an analysis of nearly half a million common surgeries performed at 87 U.S. hospitals, the Epic Health Research Network found that the number of opioid pills prescribed to patients decreased by 50% since 2017. The surgeries included in the study were low-risk arthroscopic or laparoscopic surgeries in which small incisions are made and patients are sent home from the hospital the same day.
Researchers say outpatients are just as likely to get opioids today after surgery as they were in 2017, but they will get significantly fewer pills. For example, a typical patient recovering from arthroscopic rotator cuff surgery in 2017 was prescribed the equivalent of 60 oxycodone 5mg tablets. By the end of 2020, the average patient received about 30 tablets after that procedure.
“By reducing the number of pills that go out the door, we reduce the amount of time the patient is on opioids and we reduce their risk of long-term opioid use,” explained David Little, MD, a Physician Liaison with Epic Health.
“The other thing that happens when someone goes home with 60 tablets of opioids is that they probably end up with 50 of them left sitting in the medicine cabinet. Those 50 pills in the medicine cabinet then become a problem in and of themselves, because patients start taking them later for unrelated stuff and they get addicted. Or the teenage child finds the pills and they start on them or take them out to be sold or give out to their friends.”
While the number of pills prescribed has declined significantly, Little told PNN they need to be reduced even more to meet treatment guidelines established by Johns Hopkins University. A patient recovering from rotator cuff surgery should only get about 20 oxycodone pills according to that guideline, which recommends that ibuprofen also be used for pain relief.
The Epic Health study did not look at what other medications were given to patients or if they were satisfied with their pain relief.
A recent Mayo Clinic study found that surgery guidelines are useful in reducing the number of pills prescribed, but sometimes go too far. While most patients were satisfied with their pain control, about 10 percent were not.
Opioid addiction is actually rare after surgery. A large 2016 study found only 0.4% of older adults were still taking opioids a year after major surgery. Another large study in 2018 found only 0.2% of patients who were prescribed opioids for post-operative pain were later diagnosed with opioid dependence, abuse or had a non-fatal overdose.
