Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members

Agniel, Denis; Brat, Gabriel; Marwaha, Jayson S.; Fox, Kathe; Knecht, Daniel; Paz, Harold L.; Bicket, Mark C.; Yorkgitis, Brian K.; Palmer, Nathan; Kohane, Isaac S.

doi:10.1001/jamanetworkopen.2022.21316

Cited by 3 publications

(2 citation statements)

References 51 publications

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“…However, the risks of opioid prescribing are not limited to patients being treated for pain. Approximately 70% of nonmedical opioid users initially obtain opioids from friends or family with a prescription, and each week of opioid prescription for a patient corresponds to a roughly 12% increase in the hazard of misuse among their family members [40,41,42 ▪ ]. This indicates the actual number of opioid prescriptions needed to harm is lower than estimates derived from examining the risk of opioid-addiction among patients alone.…”

Section: Risks Of Opioids In the Perioperative Settingmentioning

confidence: 99%

Evidence-based perioperative opioid-sparing techniques during the United States opioid crisis

Warinner¹,

Parker²,

Shapiro

et al. 2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review The current United States opioid epidemic resulted from the overprescribing of opioids by physicians and surgeons in response to deceptive and unlawful marketing campaigns by pharmaceutical companies seeking to profit from opioid sales. Surgeons have a moral obligation to employ evidence-based opioid-sparing analgesia protocols for management of perioperative pain. Recent findings Recent evidence strongly supports the use of NSAIDs in perioperative pain management, with large studies demonstrating no increased risk of postoperative hemorrhage or renal insult. Summary We present an evidence-based approach for opioid-sparing perioperative pain management, including multimodal analgesia guidelines used at our center for patients undergoing free flap facial reanimation procedures.

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Section: Risks Of Opioids In the Perioperative Settingmentioning

confidence: 99%

Evidence-based perioperative opioid-sparing techniques during the United States opioid crisis

Warinner¹,

Parker²,

Shapiro

et al. 2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…Opioids prescribed after surgery are a significant driver of chronic opioid use and opioid use disorder. [1][2][3][4] Postoperative opioid prescriptions also contribute to unused pills available for diversion to the community 5,6 ; more than half of the opioids prescribed are never used by the patient and rarely disposed of safely. [7][8][9] High-risk opioid prescribing is concentrated among surgeons who write the most prescriptions, with the top 5% of surgeons in terms of prescribing accounting for 40% of prescriptions written for large quantities.…”

Section: Introductionmentioning

confidence: 99%

Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions

Wagner,

Kirkegaard,

Mariano

et al. 2024

JAMA Health Forum

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ImportanceExcess opioid prescribing after surgery can result in prolonged use and diversion. Email feedback based on social norms may reduce the number of pills prescribed.ObjectiveTo assess the effectiveness of 2 social norm-based interventions on reducing guideline-discordant opioid prescribing after surgery.Design, Setting, and ParticipantsThis cluster randomized clinical trial conducted at a large health care delivery system in northern California between October 2021 and October 2022 included general, obstetric/gynecologic, and orthopedic surgeons with patients aged 18 years or older discharged to home with an oral opioid prescription.InterventionsIn 19 hospitals, 3 surgical specialties (general, orthopedic, and obstetric/gynecologic) were randomly assigned to a control group or 1 of 2 interventions. The guidelines intervention provided email feedback to surgeons on opioid prescribing relative to institutionally endorsed guidelines; the peer comparison intervention provided email feedback on opioid prescribing relative to that of peer surgeons. Emails were sent to surgeons with at least 2 guideline-discordant prescriptions in the previous month. The control group had no intervention.Main Outcome and MeasuresThe probability that a discharged patient was prescribed a quantity of opioids above the guideline for the respective procedure during the 12 intervention months.ResultsThere were 38 235 patients discharged from 640 surgeons during the 12-month intervention period. Control-group surgeons prescribed above guidelines 36.8% of the time during the intervention period compared with 27.5% and 25.4% among surgeons in the peer comparison and guidelines arms, respectively. In adjusted models, the peer comparison intervention reduced guideline-discordant prescribing by 5.8 percentage points (95% CI, −10.5 to −1.1; P = .03) and the guidelines intervention reduced it by 4.7 percentage points (95% CI, −9.4 to −0.1; P = .05). Effects were driven by surgeons who performed more surgeries and had more guideline-discordant prescribing at baseline. There was no significant difference between interventions.Conclusions and RelevanceIn this cluster randomized clinical trial, email feedback based on either guidelines or peer comparison reduced opioid prescribing after surgery. Guideline-based feedback was as effective as peer comparison-based feedback. These interventions are simple, low-cost, and scalable, and may reduce downstream opioid misuse.Trial RegistrationClinicalTrials.gov NCT05070338

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Association between Initial Opioid Prescription and Patient Pain with Continued Opioid Use among Opioid-Naïve Patients Undergoing Elective Surgery in a Large American Health System

Babatunde

Rennert

Walker

et al. 2023

IJERPH

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There is growing concern about the over-prescription of opioids and the risks of long-term use. This study examined the relationship between initial need (pre-operative, post-operative, and discharge pain) and dosage of opioids in the first prescription after surgery with continued opioid use through opioid refills over 12 months, while considering patient-level characteristics. A total of 9262 opioid-naïve patients underwent elective surgery, 7219 of whom were prescribed opioids following surgery. The results showed that 17% of patients received at least one opioid refill within one year post-surgery. Higher initial opioid doses, measured in morphine milligram equivalent (MME), were associated with a greater likelihood of continued use. Patients receiving a dose greater than 90 MME were 1.57 times more likely to receive a refill compared to those receiving less than 90 MME (95% confidence interval: 1.30–1.90, p < 0.001). Additionally, patients who experienced pain before or after surgery were more likely to receive opioid refills. Those experiencing moderate or severe pain were 1.66 times more likely to receive a refill (95% confidence interval: 1.45–1.91, p < 0.001). The findings highlight the need to consider surgery-related factors when prescribing opioids and the importance of developing strategies to balance the optimization of pain management with the risk of opioid-related harms.

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Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members

Abstract: This cohort study examines the association between the receipt of opioid prescriptions after surgery and the risk of opioid misuse and chronic opioid use among family members of the patient.

Cited by 3 publications

References 51 publications

Evidence-based perioperative opioid-sparing techniques during the United States opioid crisis

Evidence-based perioperative opioid-sparing techniques during the United States opioid crisis

Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions

Association between Initial Opioid Prescription and Patient Pain with Continued Opioid Use among Opioid-Naïve Patients Undergoing Elective Surgery in a Large American Health System

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