Postsurgery guideline could reduce opioid prescriptions by as much as 40 percent

November 30, 2017, American College of Surgeons

Rising rates of opioid prescriptions have been linked to the opioid epidemic, and a significant number of opioid deaths have been linked to prescriptions written by surgeons. However, new study results suggest that a more vigilant prescribing guideline for surgeons could reduce by as much as 40 percent the number of opioid pills prescribed after operations, and still meet patients' pain management needs. Study findings were published as an "article in press" on the Journal of the American College of Surgeons website ahead of print.

Lead study author Richard J. Barth Jr., MD, and colleagues at Dartmouth Hitchcock Medical Center in Lebanon, NH, have suggested the guideline. "We specifically looked at the number of opioid pills that surgical inpatients took the day before discharge from the hospital, and we found that this number was the strongest predictor of how many opioid pills the patients would use after discharge," Dr. Barth said.

The recommendation does not mean patients won't get enough pills to manage their pain after they leave the hospital. "The guideline was based on satisfying at least 85 percent of patients' home opioid requirement," Dr. Barth said.

The study included 333 hospital inpatients discharged to home after six different types of general surgery operations: bariatric procedures; operations on the stomach, liver, and pancreas; ventral hernia repair; and colon operations. The researchers followed up with the patients after discharge by using questionnaires and phone surveys; 90 percent of the discharged patients completed the follow-up process. The study group did not include any chronic opioid users.

This study represents the first time that specific guidelines have been proposed for prescribing opioids upon discharge after general surgery operations that require inpatient admission. Although some states have adopted laws to curb opioid prescriptions, they are ambiguous. Dr. Barth noted that several New England states limit doctors to prescribing a seven-day supply of opioids, but they include no limits on dosing. "So a seven-day supply could be 84 pills or 21 pills," he said.

The researchers found that patients typically took only a fraction of the opioids prescribed at discharge once they went home. While 85 percent of patients were prescribed an opioid after they went home, only 38 percent of prescribed opioid pills were taken. The study also looked at why a small fraction of patients took more opioids than the new guidelines called for. "Over half of them were taking opioids for non-pain-related reasons, such as to sleep better, or because they felt they should take all the pills the physician prescribed and other various and sundry reasons," Dr. Barth said.

Patients who undergo operations have a higher risk of becoming chronic opioid users than non-surgical patients do, according to previously published research Dr. Barth and his colleagues cited.1-4 Also, unused opioid pills laying around the home contribute to chronic opioid use; 71 percent of chronic opioid users receive their pills through diversionary methods like a relative's unused prescription.4,5

The guideline Dr. Barth and colleagues developed recommends the following schedule for post-discharge prescription based on the number of opioid pills taken the day before discharge: no pills for patients who took no opioids the day before they left the hospital; 15 pills for those who took one to three pills the day before; and 30 pills for those who took four or more pills on their last day in the hospital.

"This guideline was true for multiple different operations," Dr. Barth said. "It didn't matter whether someone had a colon operation, liver procedure or hernia repair; no matter what type of general surgery operation they had, this association held throughout all procedures studied. So the beauty of this finding is that one guideline would apply for multiple different surgical procedures."

A second factor that influenced patient use after surgery was age. "Patients who were older ended up taking fewer opioids than younger patients," he said. Patients younger than age 60 averaged about 13 pills after discharge while those 60 and older averaged four pills.

The increased use of e-prescribing—in which a physician can send an electronic prescription directly to a pharmacy—is another factor that should encourage physicians to write prescriptions for fewer pills after surgery. "With e-prescribing, don't have to come back to the clinic if they need more pills," Dr. Barth said.

The guideline has already been adopted at Dr. Barth's institution and can easily be applied at other centers, he said.

Explore further: Doctors prescribing too many opioids after nose jobs

More information: A Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. Journal of the American College of Surgeons. Available at: www.journalacs.org/article/S10 … (17)32055-0/abstract

Related Stories

Doctors prescribing too many opioids after nose jobs

November 9, 2017
(HealthDay)—Could some patients recovering from a nose job get a problem they didn't bargain for?

Opioids following cesarean delivery may be over-prescribed

June 8, 2017
Cesarean delivery is the most common inpatient surgical procedure in the United States, with 1.4 million c-sections performed each year. Opioids, most commonly oxycodone, are the standard pain medications prescribed to women ...

Study finds common surgeries may serve as pathway to nonmedical opioid use in adolescents

September 15, 2017
Research being presented at the American Academy of Pediatrics 2017 National Conference and Exhibition shows that post-surgical opioid pain medications prescribed after common surgeries may become a pathway to continued, ...

Opioids often overprescribed in patients undergoing surgery

July 17, 2017
(HealthDay)—For patients undergoing common elective procedures, opioids are often overprescribed, according to a study published online July 10 in the Annals of Surgery.

How many opioid pain pills do surgery patients need? New prescribing guide available

October 16, 2017
How many prescription pain pills should a patient receive after breast cancer surgery? Or a hernia repair? Or a gallbladder removal?

Even small quantities of opioids prescribed for minor injuries increase risk of long-term use

May 17, 2017
Overprescribing of opioid medications for pain has contributed to a record-high number of drug-related deaths in the United States in recent years. A significant part of the issue, experts say, is the vast amount of variation ...

Recommended for you

Health insurer policies may discourage use of non-opioid alternatives for lower back pain

October 5, 2018
Public and private health insurance policies in the U.S. are missing important opportunities to encourage the use of physical therapy, psychological counseling and other non-drug alternatives to opioid medication for treating ...

Opioid overdoses, depression linked

October 3, 2018
The link between mental health disorders and substance abuse is well-documented. Nearly one in 12 adults in the U.S is depressed, and opioid-related deaths are skyrocketing. As these numbers continue to climb, some mental ...

Do price spikes on some generic drugs indicate problems in the market?

October 1, 2018
A new USC study reports that sudden price spikes for some generic drugs—such as the recently reported increases of a decades-old generic heart medication and an antibiotic—are becoming more common.

Reclassification recommendations for drug in 'magic mushrooms'

September 26, 2018
In an evaluation of the safety and abuse research on the drug in hallucinogenic mushrooms, Johns Hopkins researchers suggest that if it clears phase III clinical trials, psilocybin should be re-categorized from a schedule ...

New study finds concurrent use of prescription drugs and dietary supplements could pose health risks

September 25, 2018
A new University of Hertfordshire study found that using certain over-the-counter herbal medicines and dietary supplements alongside prescription drugs could pose serious health risks, especially amongst older adults.

Drug overdose epidemic has been growing exponentially for decades

September 20, 2018
Death rates from drug overdoses in the U.S. have been on an exponential growth curve that began at least 15 years before the mid-1990s surge in opioid prescribing, suggesting that overdose death rates may continue along this ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.