he last few decades have seen a considerable increase in opioid-associated deaths in the United States. As per the US Centers for Disease Control and Prevention, more than 200 000 people have died from opioidassociated overdoses in the United States from 1999 through 2016, with 5 times more people dying from prescription opioids in 2016 than in 1999; in US adults younger than 50 years, drug overdose has become the number 1 cause of mortality, and the rates are higher in men than women and higher in non-Hispanic white individuals than other racial/ethnic groups. 1,2 In addition, the rates are increasing in the older population as well. 3 This prompted the establishment of a 5-point plan to combat opioid abuse, misuse, and overdose by the US Department of Health and Human Services in 2017. 4 While opioids have proven effective analgesics in a wide range of ophthalmic settings, attention is turning to how they are used in ophthalmology. [5][6][7][8][9][10] Patel and Sternberg 11 conducted a study characterizing opioid-prescription patterns by ophthalmologists within Medicare. They showed that about 90% of ophthalmologists wrote fewer than 10 opioid prescriptions annually, and approximately 1% wrote more than 100 prescriptions annually. Charlson and coworkers 12 specifically focused on oculoplastic surgeons and found that they wrote a mean of 45 opioid prescriptions per year, with 45% writing fewer than 10 and 14.8% writing IMPORTANCE Opioid abuse has been declared a public health emergency. Currently, little is known about the association between opioids and ocular surgery. OBJECTIVE To characterize rates of filled opioid prescriptions after incisional ocular surgeries.
DESIGN, SETTING, AND PARTICIPANTSThis cohort study included patients with incisional ocular surgeries within a large national US insurer's administrative medical claims database. All incisional ocular surgeries from January 2000 through December 2016 were evaluated. An opioid prescription was eligible if it occurred from 1 day before to 7 days after a surgery. Any surgery on a patient who was younger than 18 years, had more than 30 consecutive days of an opioid prescription in the prior 6 months, or had less than 6 months of data in the database prior to surgery was excluded. Data analysis occurred from May 2018 through November 2018.
MAIN OUTCOMES AND MEASURESThe rate of opioid prescriptions filled for all incisional ocular surgeries from 2000 through 2016. Primary analysis looked at the rate of filled opioid prescriptions for each ophthalmic subspecialty surgery over time. Secondary analysis assessed which patient or surgical characteristics (ie, age, sex, race/ethnicity, geographic locations, yearly income, educational level, and type of eye surgery) were associated with filling an opioid prescription. Multivariate logistic regression using generalized estimating equations was used to determine odds ratios (ORs) of filling an opioid prescription.RESULTS A total of 2 407 962 incisional ocular surgeries were included, of which 45 776 (1.90%) were as...