Opioid Prescription Quantities Research Articles

Postoperative Opioid Use Using Enhanced Recovery After Surgery Guidelines for Benign Gynecologic Procedures

To evaluate opioid use after benign gynecologic surgery after implementation of Enhanced Recovery After Surgery (ERAS) opioid prescribing recommendations. A prospective cohort study. An academic tertiary care hospital. All patients undergoing elective benign gynecologic surgery at a large academic institution between August 2017 and December 2017, 1 year after ERAS postoperative opioid prescribing recommendations were implemented for the benign gynecologic surgery department. A chart review determining opioid prescription quantity and a patient telephone survey 7 days after surgery were both performed. Total opioid use was calculated. Physician adherence to the institution's ERAS postoperative opioid prescribing recommendations after benign gynecologic surgery was then determined. Patients were classified as either in the physician adherent to ERAS group or the physician nonadherent to ERAS group. After this stratification, patients' total opioid use within each group was then compared. A total of 241 consecutive benign gynecologic surgical procedures were reviewed. Opioids were prescribed for outpatient postoperative pain management in 186 (77.2%) of these procedures. Physician adherence to the ERAS postoperative opioid prescribing recommendations occurred in 150 (62.2%) of all surgical cases. The telephone survey was completed by 144 (59.8%) patients 7 days after their surgery. Among survey participants, a total of 13 783.5 morphine milligram equivalents (MMEs) or 64.7% of all opioids prescribed were unused 7 days after surgery. This is equivalent to 1838 oxycodone 5-mg tablets unused by the end of the study period. For all surgical procedure types, the ERAS-nonadherent group was prescribed statistically significantly more opioids per patient than the ERAS-adherent group (246.2 ± 22.8 MME vs 81.1 ± 6.2 MME, p < .005), resulting in more opioids unused among the ERAS-nonadherent group. Consequently, the ERAS-nonadherent group contributed 63.5% (8747.5 MMEs) of the total unused opioids by the end of the study period despite only making up 39.6% of the completed patient surveys. Patients require significantly less opioids after benign gynecologic surgery than they are being prescribed. Physician adherence to the ERAS postoperative opioid recommendations is suboptimal and contributes significantly to the quantity of unused opioids after surgery for benign gynecologic indications. Almost two thirds of all opioids prescribed are not used by 1 week after benign gynecologic surgery.

(366) Opioid Prescription Practices in the Setting of Pediatric Fractures

Opioids are frequently prescribed to children with fractures. Although much research has been done surrounding the use of opioids in adult populations, use of opioids among children is much less understood. The purpose of this study was to investigate pediatric opioid prescription trends over the last ten years, and to compare prescription practices between doctors of different specialties. We performed a retrospective analysis of all patients age 0-18 who presented to an urban ED between 2007-2017 for fracture care. Data collected included age, opioids given in the ED, opioid prescriptions from the ED, follow-up appointment specialty, and opioid prescriptions from the first follow-up visit. Opioid prescription quantities were assessed in morphine equivalents (MEs). From pilot data of 1,387 patients with fractures, 488 patients (35.2%) received an opioid medication in the ED. Morphine (202, 14.6%) and oxycodone (191, 13.7%) were the most common opioids give in the ED setting though oral hydrocodone and codeine, and IV fentanyl and hydrocodone were also used. Opioid prescriptions from the ED were given to 491 patients (35.4%), with a mean quantity of 111.7 MEs (SD=74.4). 1,059 patients attended a follow-up appointment. 47 of the 844 (6.7%) patients who followed-up with orthopedics, and 14 of the 103 (13.5%) who followed up with plastics received opioid prescriptions. The mean quantity of opioid prescribed at the first follow-up visit was 256.1 MEs (SD=162.9). Preliminary data suggests that larger quantities of opioids are given at follow-up visits than are given in the ED. For pediatric fractures, plastic surgeons prescribe opioids twice as frequently as orthopedic surgeons. The next step for this research to draw comparisons between patients of different age groups and different fracture types.

Stated Pain Levels, Opioid Prescription Volume, and Chronic Opioid Use Among United States Army Soldiers.

The use of opioids has increased drastically over the past few years and decades. As a result, concerns have mounted over serious outcomes associated with chronic opioid use (COU), including dependency and death. A greater understanding of the factors that are associated with COU will be critical if prescribers are to navigate potentially competing objectives to provide compassionate care, while reducing the overall opioid use problem. In this study, we study pain levels and opioid prescription volumes and their effects on the risk of COU.This study leveraged passive data sources that support automated decision support systems (DSSs) currently employed in a large military population. The models presented compute monthly, person-specific, adjusted probability of subsequent COT and could potentially provide critical decision support for clinicians engaged in pain management. The study population included all outpatient presentations at military medical facilities worldwide among active duty United States Army soldiers during July 2011 to September 2014 (17,664,006 encounters; population N = 552,193). We conducted a retrospective cohort study of this population and employed longitudinal data and a discrete time multivariable logistic regression model to compute COT probability scores. The contribution of pain scores and opioid prescription quantities to the probability of COT represented analytic foci. There were 13,891 subjects (2.5%) who experienced incident COT during the observed time period. Statistically significant interactions between pain scores and prescription quantity were present, in addition to effects of multiple other control variables. Counts of monthly opioid prescriptions and maximum stated pain scores per month were each positively associated with COT. A wide range in individual COT risk scores was evident. The effect of prescription volume on the COT risk was larger than the effect of the pain score, and the combined effect of larger pain scores and increased prescription quantity was moderated by the interaction term. The results verified that passive data on the US Army can support a robust COT risk computation in this population. The individual, adjusted risk level requires statistical analyses to be fully understood. Because the same data sources drive current military DSSs, this work provides the potential basis for new, evidence-based decision support resources for military clinicians. The strong, independent impact of increasing opioid prescription counts on the COT risk reinforces the importance of exploring alternatives to opioids in pain management planning. It suggests that changing provider behavior through enhanced decision support could help reduce COT rates.

Do primary care providers who prescribe more opioids have higher patient panel satisfaction scores?

Objectives:Opioid prescribing in the United States has tripled since 1999. At the same time, there has been increasing attention to patient satisfaction. It has been suggested that providers concerned about patient satisfaction may be more likely to treat pain with opioids. We examined primary care providers’ opioid prescribing practices to determine if higher provider opioid prescribing was associated with higher patient satisfaction.Methods:For 77 primary care providers, we compared each provider’s opioid prescription count and amount prescribed to each provider’s patient panel satisfaction measures. Satisfaction measures were obtained from surveys following office visits and consisted of Likert-type scale answers concerning satisfaction for pain management and other provider satisfaction domains. Satisfaction surveys were generated independent of patient complaint of pain and had the aim of overall assessment of patient satisfaction with the provider and the healthcare system. We assessed the correlation between opioid prescribing and patient panel pain management satisfaction using linear regression models with and without adjustment for patient complexity.Results:We observed no statistically significant correlation between patient panel satisfaction with their provider and the quantity of opioids that the provider prescribed (R2 = 0.006; p = 0.52). There was also no correlation between patient panel satisfaction and the number of opioid prescriptions written by their provider (R2 = 0.005; p = 0.54). Additional multivariate analysis after adjusting for patient complexity also demonstrated no correlation of pain management satisfaction with opioids prescribed. Although the quantity of opioid prescriptions was not correlated with pain management satisfaction, several other patient satisfaction measures correlated significantly with pain management satisfaction.Conclusion:Primary care providers with a greater rate of opioid prescribing did not have higher patient panel satisfaction scores for pain management. In primary care, providers who want to improve patient satisfaction should focus on other components of patient care besides opioid-based pain management.

The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio

The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians. We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids. Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95%CI-18.8%to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect. In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our findings suggest an additional effect of the guidelines on prescribing behavior. Similar guidelines may have the potential to reduce opioid prescribing in other geographic areas and for other specialties as well.