Effect of Opioid Limiting Legislation on Postoperative Opioid Utilization in Patients Treated for Ankle Fractures

Abstract

Background: The state of Ohio implemented legislation in August of 2017 limiting the quantity of opioids a provider could prescribe. The purpose of this study was to identify if implementation of legislation affected opioid and nonopioid utilization in patients operatively treated for ankle fractures in the initial 90-day postoperative period after controlling for injury severity and preoperative narcotic usage. Methods: A retrospective review of 144 patients treated for isolated ankle fractures in a pre-law group (January 2017–July 2017; n = 73) and post-law group (January 2018–July 2018; n = 71) was completed using electronic medical records and a legal prescriber database. Total number of opioid prescriptions, pills, milligrams of morphine equivalents (MMEs), and nonopioid prescriptions were recorded. Multiple regression analysis was run to identify predictors of opioid prescribing after controlling for law group, demographic, preoperative narcotic use, and injury severity characteristics. Results: Mean MME prescribed per patient significantly decreased from 817.2 MME pre-law to 380.9 post-law ( P < .01). Mean number of opioid pills prescribed per patient decreased from 99.1 in the pre-law group and 55.3 in the post law group ( P < .001), respectively. Multiple linear regression analysis to predict the mean number of opioid pills prescribed was statistically significant ( R 2 = 0.33; P < .001), with law group adding significantly to the prediction ( P < .001). The multiple linear regression analysis to predict MME per patient was found to be statistically significant ( R 2 = 0.31; P < .001), with the law group contributing significantly ( P < .001). Conclusion: The Ohio prescriber law successfully contributed to the decreased number of opioid pills and MME prescribed in the initial 90-day postoperative period after controlling for injury severity and preoperative narcotic usage. Policies on opioid prescriptions may serve as an important public health tool in the fight against the opioid epidemic. Level of Evidence: Level III, retrospective comparative series.