Opioid Prescriptions For Patients Research Articles

Opioid prescribing trends and pain scores among adult patients with cancer in a large health system.

11059 Background: Some opioid stewardship policies could negatively affect patients with cancer pain. However, patients with cancer are also at risk for opioid related harms, especially with persistent use. We assessed opioid prescribing trends in the context of cancer treatment and patient reported pain in a large health system in Connecticut. Methods: We conducted a retrospective cohort study of opioid-naïve adult patients with solid tumor malignancies diagnosed from 2016 through 2020 within the Yale New Haven Health System. We identified new (≥1 opioid prescription in 0-6 months following diagnosis) and additional (0-6 and 6-9 months) opioid prescriptions. The analysis evaluated all eligible patients as well as two clinical cohorts: patients treated surgically and patients with metastatic cancer. For patients with metastatic cancer and a documented pain score in the electronic health record flowsheet data, we further stratified by any (any score≥1) or no (all scores=0) pain in the 6 months since diagnosis and prior to first opioid, if given. For these patients, we noted therapeutic class of the first opioid. We used a logistic model adjusted for patient demographics to calculate predicted probability of opioid prescription and change over time. Results: A total of 10,868 patients met study criteria. Overall, we observed a decline in new opioid prescribing from 69.0% to 62.7% (p<.001) (Table). Additional opioid use also declined from 23.4% to 20.2% (p=.02). In the surgery cohort, new opioid prescribing fell from 95.7% to 88.2% (p<.001), while additional opioid use was stable over time (approximately 12%). For patients with metastatic cancer with any documented pain, new opioid prescribing was stable over time (approximately 56%). For those with documented pain scores=0, new opioid prescribing declined from 59.7% to 34.2% (p<.001). In these patients, the class listed on the first opioid prescription was analgesia in 86.6% and cough in 13.4%. Conclusions: Overall, and in patients treated with oncological surgeries, our study in a single large US health system suggests a modest, gradual decline in opioid prescribing for patients with cancer over time. On the other hand, among patients with metastatic cancer, opioid prescribing remained stable for those with documented pain and declined steeply for those without documented pain. [Table: see text]

High prevalence of severe pain is associated with low opioid availability in patients with advanced cancer: Combined database study and nationwide questionnaire survey in Japan.

Opioid availability for the palliative care of patients with advanced cancer is increasing globally. However, opioid availability remains extremely low in Japan. We investigated whether pain is appropriately controlled by low-dose opioid prescriptions in patients with advanced cancer in Japan. A web-based nationwide survey for caregivers from 2000 community comprehensive support care centers was performed in Japan to assess details about pain in the 30 days before patients died of end-stage cancer. Separately, the data for opioid prescription doses and medical services in the 90 days before the death of patients with cancer were extracted from a health insurance claim database. Responses from 1034 responders were retrieved and 665 patients were included. In total, 254 patients (38.2%) complained of severe-to-intolerable cancer-related pain. The median cumulative prescription dose of opioids in the 90 days before patient death was 311.0 mg by oral morphine equivalent doses. Multiple regression analyses across prefectures revealed that the proportion of patients with severe-to-intolerable cancer-related pain was negatively associated with the cumulative opioid consumption expressed as morphine-equivalent doses within 90 days before death. The very low availability of opioids for patients with end-stage cancer could result in high rate of severe-to-intolerable cancer-related pain patients. There were several limitations in this study, and the interpretations of the findings should be carefully. However, the increase in the absolute dose of opioids could improve the palliative care framework to the pain control levels of the global standard.

Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic cancer pain.

Data indicates that clinicians might be under-prescribing opioids for patients with chronic cancer pain, and this could impact adequate pain management. Few studies have sought to understand healthcare provider (HCP) perceptions and practices regarding the prescription of opioids for chronic cancer pain. We assessed HCP perceptions and practices regarding opioid prescription for patients with chronic cancer pain since the onset of the COVID-19 pandemic. An anonymous cross-sectional survey was conducted among 186 HCPs who attended an opioid educational event in April 2021 and 2022. Sixty-one out of 143 (44%) opioid prescribers reported reluctance to prescribe opioids for chronic cancer pain. In a multivariate logistic model, younger participants (log OR - 0.04, 95% CI - 0.085, - 0.004; p = 0.033) and pain medicine clinicians (log OR - 1.89, CI - 3.931, - 0.286; p = 0.034) were less reluctant, whereas providers who worry about non-medical opioid use were more reluctant to prescribe opioids (log OR 1.58 95% CI 0.77-2.43; p < 0.001). Fifty-three out of 143 (37%) prescribers had experienced increased challenges regarding opioid dispensing at pharmacies, and 84/179 (47%) of all respondents reported similar experience by their patients. Fifty-four out of 178(30%) were aware of opioid-related harmful incidents to patients or their families, including incidents attributed to opioid misuse by a household or family member. A considerable number of opioid prescribers were reluctant to prescribe opioids for patients with chronic cancer pain. Many reported challenges regarding dispensing of opioids at the pharmacies. These may be unintended consequences of policies to address the opioid crisis. Future measures should focus on addressing regulatory barriers without undermining the gains already made to combat the opioid crisis.

Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain

ObjectiveTo determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain. Patients and MethodsWe identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics. ResultsWithin 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65). ConclusionIn general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates.

Opioid Prescription in Patients With Chronic Kidney Disease: A Systematic Review of Comparing Safety and Efficacy of Opioid Use in Chronic Kidney Disease Patients.

Patients with diminished renal function necessitate special care. In patients with chronic kidney disease (CKD), opioid analgesics should be prescribed based on the severity of renal insufficiency; this will determine treatment options at the beginning and throughout the management of pain in CKD patients. The dosage of hydrophilic drugs and drugs with active metabolites should be adjusted according to the severity of CKD, and the process of treatment should be monitored by modifying drug dosages as necessary for background and breakthrough pain. Patients with CKD may benefit from opioid analgesics that are lipophilic, such as methadone, fentanyl, and buprenorphine, as the first line; however, fentanyl is inappropriate for patients undergoing hemodialysis. Opioid prescription in CKD patients is the subject of this systematic review, which aims to compare their safety and efficacy. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. Using three databases (PubMed, ScienceDirect, and Google Scholar), we collected and reviewed articles, including literature reviews, randomized control trials (RCTs), and systematic reviews published between 1980 and 2022, to enable us to gather enough valuable data on this rare topic. After applying appropriate filters, a total of 109 results were obtained. They were further screened and subjected to quality assessment tools, which finally yielded 11 studies included in this systematic review. This consisted of two RCTs, two systematic reviews, and seven narrative reviews. This review focused on the safety and appropriate use of opioids in patients with CKD. The accumulation of morphine and codeine metabolites may result in neurotoxic side effects. Hydromorphone and oxycodone are considered safe to administer but require careful adjustments in dosage. Common comorbidities among patients with CKD may amplify opioid-related adverse effects.

Racial and Ethnic Disparities in Opioid Prescriptions for Patients with Abdominal Pain: Analysis of the National Ambulatory Medical Care Survey.

Disparities in pain control have been extensively studied in the hospital setting, but less is known regarding the racial/ethnic disparities in opioid prescriptions for patients with abdominal pain in ambulatory clinics. We examined opioid prescriptions during visits by patients presenting with abdominal pain between the years of 2006 and 2015, respectively, in the National Ambulatory Medical Care Survey database. Data weights for national-level estimates were applied. We identified 4006 outpatient visits, equivalent to 114 million weighted visits. Rates of opioid use was highest among non-Hispanic White patients (12%), and then non-Hispanic Black patients (11%), and was the lowest in Hispanic patients (6%). Hispanic patients had lower odds of receiving opioid prescriptions compared to non-Hispanic White patients (OR = 0.49; 95% CI, 0.31-0.77, p = 0.002) and all non-Hispanic patients (OR 0.48; 95% CI 0.30-0.75; p = 0.002). No significant differences were noted in non-opioid analgesia prescriptions (p = 0.507). A higher frequency of anti-depressants/anti-psychotic prescriptions and alcohol use was recorded amongst the non-Hispanic patients (p = 0.027 and p = 0.001, respectively). Rates of opioid prescriptions for abdominal pain patients were substantially lower for the Hispanic patients compared with the non-Hispanic patients, despite having a decreased rate of high-risk features, such as alcohol use and depression. The root cause of this disparity needs further research to ensure equitable access to pain management.

Examining the effects of physician burnout on pain management for patients with advanced lung cancer.

Physician burnout is generally associated with worse clinical outcomes. The purpose of this study is to examine the effects of physician burnout on the quality of physicians' pain assessment and opioid prescribing for patients with advanced lung cancer. Moreover, we test whether these relationships are moderated by patient-level factors, such as patient race and activation level, that have a demonstrated impact on clinical encounters. We conducted a secondary analysis of data from a multisite randomized field experiment. From 2012 to 2016, 96 primary care physicians and oncologists who treated solid tumors were recruited from hospitals and medical sites in three small metropolitan and rural areas in the USA. Physicians saw two unannounced standardized patients who presented with advanced lung cancer. Standardized patients varied across race (Black or White) and activation level (activated, typical). Visits were audio recorded and transcribed. Pain management was evaluated by the quality of pain assessment and opioid prescribing during these visits. Mixed-effects linear regression and generalized mixed-effects modeling showed that higher levels of burnout were associated with a greater likelihood of prescribing an opioid and prescribing stronger opioid doses for patients. These effects were not moderated by patient race or activation level. Findings from this work inform our understanding of physician-level factors that impact clinical decision-making in the context of cancer pain management. Specifically, this study identifies the role of physician burnout on the quality of prescribing for patients with advanced lung cancer.

Mismatched opioid prescription in patients discharged after neurological surgeries: a retrospective cohort study.

Although postsurgical overprescription has been well-studied, postsurgical opioid underprescription remains largely overlooked. This retrospective cohort study was to investigate the extent of discharge opioid overprescription and underprescription in patients after neurological surgeries. Six thousand nine hundred forty-nine adult opioid-naive patients who underwent inpatient neurosurgical procedures at the University of California San Francisco were included. The primary outcome was the discrepancy between individual patient's prescribed daily oral morphine milligram equivalent (MME) at discharge and patient's own inpatient daily MME consumed within 24 hours of discharge. Analyses include Wilcoxon, Mann-Whitney, Kruskal-Wallis, and χ 2 tests, and linear or multivariable logistic regression. 64.3% and 19.5% of patients were opioid overprescribed and underprescribed, respectively, with median prescribed daily MME 360% and 55.2% of median inpatient daily MME in opioid overprescribed and underprescribed patients, respectively. 54.6% of patients with no inpatient opioid the day before discharge were opioid overprescribed. Opioid underprescription dose-dependently increased the rate of opioid refill 1 to 30 days after discharge. From 2016 to 2019, the percentage of patients with opioid overprescription decreased by 24.8%, but the percentage of patients with opioid underprescription increased by 51.2%. Thus, the mismatched discharge opioid prescription in patients after neurological surgeries presented as both opioid overprescription and underprescription, with a dose-dependent increased rate of opioid refill 1 to 30 days after discharge in opioid underprescription. Although we are fighting against opioid overprescription to postsurgical patients, we should not ignore postsurgical opioid underprescription.

Evaluation of a Quality Improvement Bundle Aimed to Reduce Opioid Prescriptions After Cesarean Delivery: An Interrupted Time Series Study

(Can J Anesth/J Can Anesth. 2022;69:1007–1016) There are efforts from the medical community and the public to reduce the prescription of opioids in the United States and Canada. Quality improvement (QI) initiatives have been successfully used to reduce opioid prescriptions in patients undergoing cesarean delivery (CD). This study assessed opioid prescribing rates following a quality improvement initiative, hypothesizing there would be a lower rate of opioid prescription in post-CD patients following implementation of the QI bundle.

Discharge Opioid Over- and Underprescription to Patients after General Surgery: A Retrospective Cohort Study.

Although postoperative opioid overprescription has been well studied, little is known about opioid underprescription. This study aims to determine the extent of improper discharge opioid prescription in patients undergoing general surgery procedures. This retrospective cohort study investigated opioid-naïve adult patients who underwent inpatient general surgery at an academic medical center between June 2012 and December 2019. The primary outcome was the difference between individual patient's inpatient daily oral morphine milligram equivalent (MME) 24 hours before discharge and patient's prescribed daily MME at discharge. The data were analyzed using chi-square, Mann-Whitney, Wilcoxon, and Kruskal-Wallis tests and multivariable logistic regression. Among 5,531 patients, 58.1% had opioid overprescription, and 22.4% had opioid underprescription. Median prescribed daily MME was 311% of median inpatient daily MME in overprescribed patients and 56.3% of median inpatient daily MME in underprescribed patients. About half (52.3%) of patients who consumed no opioids on the day before discharge were opioid overprescribed, and 69.9% of patients who required inpatient daily opioid of >100 MME were opioid underprescribed. Opioid-underprescribed patients had an increased opioid refill rate 1 to 30 days after discharge, whereas opioid-overprescribed patients had an increased refill rate 31 to 60 days after discharge. From 2017 to 2019, the percentage of overprescribed patients decreased by 35.8%, but the percentage of underprescribed patients increased by 42.4%. Although avoiding postoperative opioid overprescription remains imperative, preventing postoperative opioid underprescription is also essential. We recommend using a patient-centered approach to match the daily dose of opioid prescription with each patient's inpatient daily opioid consumption.

Trust but Verify: Discordance in Opioid Reporting Between the Electronic Medical Record and a Statewide Database.

The electronic medical record (EMR) is often used as the primary source for patient medication lists and history. We sought to determine the accuracy of the EMR in documenting opioid prescriptions in patients undergoing fracture repair compared to a statewide database. This retrospective study was conducted at an urban level 1 trauma center. Patients > 18 years old were included if they were admitted directly through the emergency room with isolated single orthopedic injuries. Opioid use and prescription data prior to admission and three months following surgery were collected through the EMR and a California statewide database of controlled substance prescriptions. A 2 x 2 McNemar's test was used to identify discordance between the EMR and Controlled Substance Utilization Review and Evaluation System (CURES). A total of 369 patients were included. The EMR reported that 143 patients had an opioid prescription within 30 days prior to admissioncompared to 75 patients reported by CURES (discordance rate [DR]: 34.7%) (p < 0.001). Between postoperative days (POD) 0-30, the EMR reported that 367 patients had an opioid prescriptioncompared to 285 reported by CURES (DR: 22.8%) (p < 0.001). Between POD 30-60, the EMR reported that 142 patients had an opioid prescriptioncompared to 84 reported by CURES (DR: 34.7%) (p < 0.001). Between POD 60-90, the EMR reported that 83 patients had an active opioid prescriptioncompared to 60 patients reported by CURES (DR: 41.0%) (p = 0.10). There is a significant discordance between the databases in documenting opioid use. Physicians should check multiple sources to best assess active opioid prescriptions.

The effect of the COVID-19 pandemic on opioid prescribing for patients with pleuritic pain.

We sought to understand opioid prescribing for COVID-19 positive and negative patients with pleuritic pain during the first wave of the pandemic. We hypothesized that patients without COVID-19 would be prescribed opioids more frequently intrapandemic compared to prepandemic and postulated that COVID-19 patients would be prescribed opioids more frequently and at greater quantity than their peers. A retrospective observational analysis of electronic health record data. A quaternary academic hospital from February through April 2020. A total of 1,400 of 3,169 adult inpatient hospitalizations involving pleuritic pain were included. Frequency and average daily dose of opioid prescriptions were analyzed using logistic and linear regression. Opioid prescribing habits were compared pre- and intrapandemic. Hypotheses and primary outcome measures were formulated prior to data collection. During the pandemic, COVID-19 patients were 15.77 absolute percentage points less likely to be prescribed opioids compared to patients without COVID-19 (95 percent confidence interval (CI): -8.98 to -22.56 percent). Patients without COVID-19 were equally likely to be prescribed opioids pre- and intrapandemic (95 percent CI: -9.37 to 2.42 percent). Odds ratio of opioid prescription for COVID-19 patients was 0.44 (95 percent CI: 0.08-0.80). Within those given opioids, COVID-19 patients were prescribed 3.0 percent greater morphine milligram equivalents (MMEs) (95 percent CI: 1.07-5.85 percent). During the first wave of the pandemic, COVID-19 patients with pleuritic pain were prescribed opioids less frequently than patients without COVID-19, while patients without COVID-19 were equally likely to be prescribed opioid pre- and intrapandemic. On the other hand, COVID-19 patients treated with opioids were given greater daily MMEs due to the greater utilization of opioid infusions.

Perioperative Communication Association with Discharge Opioid Prescription in Patients with Limited English

Perioperative Communication Association with Discharge Opioid Prescription in Patients with Limited English

S92 Racial and Ethnic Disparities in Opioid Prescriptions in Benign and Malignant Pancreatic Disease in the United States, 2006-2015

Introduction: Racial and ethnic disparities in pain management are well established, but not for patients with pancreatic disease. We sought to evaluate racial-ethnic disparities in opioid prescriptions for patients with acute and chronic pancreatitis and pancreatic cancer. Methods: Data from the National Ambulatory Medical Care Survey (NAMCS) were used to examine opioid prescriptions recorded during ambulatory visits by adult pancreatic disease patients between 2006 and 2015. Diagnoses were determined by ICD-9 codes 557.0 and 577.1 for acute and chronic pancreatitis and 157 for pancreatic cancer. Visits by patients with other painful conditions associated with opioid use were excluded. Bivariate analysis was used to detect differences in opioid prescriptions by patient race, ethnicity, and sex. Data weights for national-level estimates were not applied in accordance with NAMCS guidelines requiring a relative standard error of 30% or less. Results: We identified 421 outpatient visits by adults with pancreatic disease. Eighteen patients with comorbid painful conditions (lumbago, myalgia, generalized pain, ankylosing spondylitis, osteoarthritis, multiple sclerosis, and mononeuritis) were excluded. A total of 207 pancreatitis and 196 pancreatic cancer patient visits were identified, representing 9.8 million visits, but weights were repealed for analysis. No sex differences in opioid prescriptions were found among pancreatitis (p=0.78) or pancreatic cancer patient visits (p=0.57). Opioids were prescribed at 58% of non-Hispanic Black, 37% non-Hispanic White, and 19% Hispanic pancreatitis (P=0.05) patient visits (Table). Opioid prescriptions were less common in visits by Hispanic compared to non-Hispanic pancreatitis patients (OR 0.35, 95% CI 0.14-0.91, p=0.03) and there was a trend toward higher rates in non-Hispanic Black versus non-Hispanic White patient visits. No racial-ethnic differences in opioid prescriptions were seen among pancreatic cancer patient visits. Conclusion: While racial-ethnic disparities in opioid prescriptions were observed in pancreatitis patient visits, none were seen in pancreatic cancer patient visits. These findings suggest racial and ethnic bias in opioid prescription practices for patients with painful but benign pancreatic disease, but there may be a lower threshold for opioid provision in the treatment of malignant and terminal pancreatic disease. Table 1. - Demographic characteristics and likelihood of opioid use among visits by adult pancreatitis and pancreatic cancer patients in NAMCS, 2006-2015 No opioid Opioid Prescription OR (95% CI) p-value Pancreatitis N=132 (64%) N=75 (36%) Race/Ethnicity, % A) Non-Hispanic 106 (61) 69 (39) Reference Reference Hispanic 26 (81) 6 (19) 0.35 (0.14-0.91) .03 B) White non-Hispanic 87 (63) 52 (37) Reference Reference Black non-Hispanic 10 (42) 14 (58) 2.34 (0.97-5.65) .06 Hispanic 26 (81) 6 (19) 0.39 (0.15-1.00) .05 Other non-Hispanic 9 (75) 3 (25) 0.56 (0.42-0.84) .40 Sex, % Female 59 (65) 32 (35) Reference Reference Male 73 (63) 43 (37) 1.09 (0.61-1.92) .78 Pancreatic Cancer N=126 (64%) N=70 (36%) Race/Ethnicity, % White non-Hispanic 97(64) 54(36) Reference Reference Black non-Hispanic 17(65) 9(35) 0.95 (0.40-2.28) .91 Hispanic 8(62) 5(38) 1.12 (0.35-3.60) .85 Other non-Hispanic 4(67) 2(33) 0.90 (0.16-5.06) .90 Sex, % Female 63(62) 38(38) Reference Reference Male 63(66) 32(34) 0.84 (0.47-1.51) .57

Outpatient Opioid Prescribing Habits in Pediatric Patients With Bone Sarcomas After Undergoing Primary Tumor Resection.

The majority of children with bone sarcomas experience pain. Opioids remain the mainstay treatment of cancer-related pain in children. The patterns of outpatient opioid prescription after surgery for primary bone sarcomas remains unknown. The purpose of this study is to evaluate the patterns of outpatient opioid prescription in patients with bone sarcomas after resection of the primary tumor, and to assess for factors that may lead to increased opioid dosing in these patients. A retrospective chart review of 28 patients with bone sarcomas undergoing primary tumor resection was performed. Demographic, medical, surgical, and pharmacological data was collected from all patients. The total morphine milligram equivalents (MMEs) prescribed after patient discharge were compared at 30-day intervals. The MMEs were then stratified by tumor location, presence of metastasis at time of surgery, and preoperative opioid use. Independent predictors of increased 30-day and total 120-day opioid utilization were evaluated. Patients with preoperative opioid use were prescribed significantly more opioids in every 30-day postoperative interval and for the 120-day total. When stratified by tumor location, patients with primary tumors in the pelvis had significantly greater postoperative opioid utilization when compared with patients with tumors located in the lower and upper extremities during postoperative days 61 to 90 (5970 vs. 1060.4 and 0 MMEs, respectively, P=0.048) and during postoperative days 91 to 120 (6450 vs. 829.6 and 0 MMEs, respectively, P=0.015). Older age, diagnosis of osteosarcoma, increased length of stay postoperatively and presence of metastases were associated with a higher 30-day postoperative opioid utilization. Multiple factors were associated with increased opioid use including preoperative opioid use, longer postoperative stay in the hospital, metastatic disease, and primary sarcomas in the pelvis. The patient's sex, body mass index, race, type of insurance, type of surgery performed, reoperation during the same admission and use of nonopioid adjuvants had no effect on opioid use. The results of this study can be used to stratify the average opioid requirement of pediatric patients undergoing primary bone sarcoma resection. Level IV.

Medical Cannabis Use Reduces Opioid Prescriptions in Patients With Osteoarthritis.

BackgroundOsteoarthritis (OA) can result in significant pain, requiring pain management with opioids. Medical cannabis (MC) has the potential to be an alternative to opioids for chronic pain conditions. This study investigates whether MC used in the management of OA-related chronic pain can reduce opioid utilization.MethodsForty patients with chronic OA pain were certified for MC. Average morphine milligram equivalents (MME) per day of opioid prescriptions filled within the six months prior to MC certification was compared to that of the six months after. Visual analog scale (VAS) for pain and Global Health scores were measured at baseline, three, and six months post MC certification.ResultsAverage MME/day decreased from 18.2 to 9.8 (n=40, p<0.05). The percentage of patients who dropped to 0 MME/day was 37.5%. VAS scores decreased significantly at three and six months, and Global Physical Health score increased significantly by three months.ConclusionsMC reduces opioid prescription for patients with chronic OA pain and improves pain and quality of life.

Medical Cannabis Use Reduces Opioid Prescriptions in Patients With Chronic Back Pain.

BackgroundThis study investigates whether the use of medical cannabis (MC) in patients with chronic back pain is associated with a decreased opioid prescription.MethodsThe study included 186 patients with chronic back pain who were certified for MC use. The average morphine milligram equivalent (MME)/day of opioid prescriptions filled within the six months prior to MC certification was compared to that of six months after. Pain and disability questionnaires were distributed at three, six, and nine months post-certification.ResultsPatients who started at less than 15 MME/day and patients who started at greater than 15 MME/day decreased from 15.1 to 11.0 (n = 186, p < 0.01), 3.5 to 2­­­.1 (n = 134, p < 0.01), and 44.9 to 33.9 (n = 52, p < 0.01), respectively. Pain and disability scores were improved at follow-up as well.ConclusionMC use reduces opioid prescription for patients with chronic back pain and improves pain and disability scores.

Racial disparities in opioid prescriptions for fractures in the pediatric population.

Racial disparities have been well documented in literature regarding pain management. However, few studies have focused on its effect in the pediatric population. This study seeks to examine the relationship between race and opioid prescription patterns for children with fractures. A retrospective study was conducted by reviewing all analgesic prescriptions of discharged pediatric patients (ages 0-21, median 10years) from a large children's hospital over a five-year period. Multiple logistic regression analysis was applied to examine racial differences in opioid prescriptions for patients with long bone fractures after adjusting for sex, age, length of stay, and payer type. 58,402 analgesic prescriptions were reviewed in this study; 5061 were given for the primary discharge diagnosis of "fracture" of any bone. Overall, 52% of analgesics prescribed for this diagnosis were opioid medications. The relative frequency of opioid prescriptions was 48.7% in Hispanic White patients and 63.1% in non-Hispanic White patients. The odds ratio for non-Hispanic White patients to be prescribed an opioid medication was 1.44 (CI 1.20-1.73) compared to Black patients and to Hispanic White patients after adjustment for sex, age, length of hospital stay, and payer type. The same racial disparity pattern was observed in patients regardless of long bone fracture location. Racial bias is suggested in opioid prescription patterns, even in the pediatric population, which may have untoward negative downstream effects. This study delineates the need for improved and standardized methods to adequately treat pain and reduce variations in prescriber habits.

How opioid prescribing policies influence primary care clinicians' treatment decisions and conversations with patients with chronic pain.

The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain. We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies. Opioid prescribing policies influenced clinicians' treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3). Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

Effects of State Law Limiting Postoperative Opioid Prescription in Patients After Cesarean Delivery

(Anesth Analg. 2021;132:752–760) Opioids are routinely prescribed following cesarean delivery in the United States, though 1 in 300 of these patients experience new-onset persistent opioid use. As the duration of opioid prescriptions is the strongest indicator of persistent opioid use, the State of Florida passed a law restricting the duration of opioid prescriptions for acute pain to 3 days. Prescriptions may be extended to 7 days if the prescriber documents medical necessity. Studies have been conducted examining the effects of these laws on the general surgery population, there is a lack of studies specifically exploring the impact on cesarean delivery patients. This study aimed to examine the impact of this law, HB 21, on discharge opioid prescription practices in patients undergoing cesarean delivery.