Abstract
Since the Centers for Disease Control and Prevention published opioid prescribing guidelines in March 2016, 31 states have implemented legislation to restrict the duration of opioid prescriptions for acute pain. However, the association of these policies with the amount of opioid prescribed following surgery remains unknown. To examine the association of opioid prescribing duration limits with postoperative opioid prescribing in Massachusetts and Connecticut, the first 2 states to implement limits after March 2016. This interrupted time series analysis and cross-sectional study examined immediate level and slope changes in monthly outcomes after prescribing limit implementation in Massachusetts and Connecticut. These states implemented 7-day limits on initial opioid prescriptions on March 14, 2016, and July 1, 2016, respectively. Using the 2014 to 2017 IBM MarketScan Research Database, 16 281 opioid-naive adults in these states who filled a prescription within 3 days of surgery between July 1, 2014, and November 30, 2017, were identified. Data were analyzed from December 2018 to June 2019. The primary outcome was the prescription size in oral morphine equivalents (OMEs) for the initial postoperative opioid prescription (one 5/325 mg hydrocodone-acetaminophen pill = 5 OMEs). Secondary outcomes included days supplied in the initial prescription and the proportion of initial prescriptions exceeding a 7-day supply. In total, 16 281 opioid-naive patients (9708 [59.6%] female; median [interquartile range] age range, 45-54 [35-44 to 55-64] years) undergoing surgical procedures were included. In Massachusetts, there were 5340 and 5435 patients in the preimplementation and postimplementation periods, respectively. In Connecticut, there were 2869 and 2637 patients in the preimplementation and postimplementation periods, respectively. Limit implementation in Massachusetts was associated with an immediate mean level decrease in prescription size (-38 OMEs [95% CI, -44 to -32 OMEs]) and with a mean decrease in slope (-1.5 OMEs/mo [95% CI, -2.1 to -0.9 OMEs/mo]). Implementation was also associated with an immediate mean level decrease in days supplied (-0.4 days [95% CI, -0.6 to -0.2 days]) and the proportion of prescriptions exceeding a 7-day supply (-5.9 percentage points [95% CI, -7.9 to -3.9 percentage points]). In contrast, limit implementation in Connecticut was not associated with level or slope changes in any outcome. Opioid prescribing duration limits had a variable association with postoperative opioid prescribing in Massachusetts and Connecticut. The mean opioid prescription size filled, days supplied, and prescribing exceeding a 7-day supply decreased after limit implementation in Massachusetts only. Given the potential differences in policy dissemination and uptake, efforts to reduce opioid prescribing should also include surgeon education and evidence-based prescribing recommendations.
Highlights
Excess opioid prescribing for acute pain has come under increased scrutiny in recent years as a major source of unused pills available for misuse and diversion into the community.[1,2,3,4] Opioid prescribing guidelines published by the Centers for Disease Control and Prevention in March 20165 suggest that more than a 7-day supply of opioids is rarely needed when treating acute pain
Limit implementation in Massachusetts was associated with an immediate mean level decrease in prescription size (−38 oral morphine equivalents (OMEs) [95% CI, −44 to −32 OMEs]) and with a mean decrease in slope (−1.5 OMEs/mo [95% CI, −2.1 to −0.9 OMEs/mo])
Opioid prescribing duration limits had a variable association with postoperative opioid prescribing in Massachusetts and Connecticut
Summary
Excess opioid prescribing for acute pain has come under increased scrutiny in recent years as a major source of unused pills available for misuse and diversion into the community.[1,2,3,4] Opioid prescribing guidelines published by the Centers for Disease Control and Prevention in March 20165 suggest that more than a 7-day supply of opioids is rarely needed when treating acute pain. A 7-day limit still allows for an initial prescription to range from 42 to 84 tablets of hydrocodone, if the signature is written as 1 to 2 tablets every 4 to 6 hours for 7 days.[3] Most prescribing limits have numerous exceptions, with some allowing clinicians to prescribe beyond the limit based on professional medical judgment. These regulations do not account for heterogeneity in prescribing practices that are driven by clinical and patient need. A 7-day limit could be insufficient for the most painful conditions
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
