Treading the tightrope of opioid restrictions

Eisenstein, Michael

doi:10.1038/d41586-019-02687-1

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…It seems that clinicians were increasingly aware of the potential harm of opioids, which led to reduced daily MME below 50. Although there is no widely accepted guideline for opioid prescription among metastatic breast cancer patients, there are many studies in the literature on other populations that suggested that daily dosages above 50 MME is associated with higher risk for opioid overuse, which led the Centers for Disease Control to recommend clinicians carefully reassess evidence of individual benefits and risks when considering increasing dose to > 50MME per day and avoid prescribing > 90MME per day in 2016 22 . Although this did not apply specifically to people with cancer, this opioid threshold was adopted by some regulatory organizations and insurance companies, therefore potentially impacting the prescribing habits of clinicians 22 .…”

Section: Discussionmentioning

confidence: 99%

Trends and patterns in the use of opioids among metastatic breast cancer patients

Shen

Thornton

Newport

et al. 2020

Sci Rep

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Opioid use among metastatic breast cancer (MBC) patients has not been well-studied. This study examined the trends and patterns of opioid use among working-age, privately insured patients diagnosed with MBC. Using MarketScan data, we identified female patients diagnosed with MBC in 2006–2015. We determined the proportion of patients who filled a prescription for an opioid and calculated days’ supply and daily morphine milligram equivalents (MMEs) from 1 year prior to diagnosis till 1 year after. We assessed the trend in opioid use over the 10-year study period and examined opioid usage patterns after the diagnosis of MBC. Among 24,752 patients included, 11,579 (46.8%) had an opioid prescription within 1 year before diagnosis of MBC, and 20,416 (81.4%) had an opioid prescription within 1 year after diagnosis. The proportion of patients with opioid prescriptions after diagnosis was relatively stable from 2006 to 2015. However, both the median daily MME and median days’ supply decreased over time with most of the decline from the subgroup of patients with prior prescription opioid use. Most patients received an opioid prescription in the first month after diagnosis (57.3%), dropping to approximately 20% from 3 to 12 months after diagnosis. Also, the median days’ supply increased substantially during the year after diagnosis for patients who received opioids (from 7 to 19). Most women with MBC require opioid analgesia within the first month after diagnosis. Judicious, long-term management of pain after diagnosis of MBC will continue to be necessary for many patients.

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Section: Discussionmentioning

confidence: 99%

Trends and patterns in the use of opioids among metastatic breast cancer patients

Shen

Thornton

Newport

et al. 2020

Sci Rep

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“…Two veterans [VET01, VET03] , however, provided negative feedback regarding the VA health system, and one veteran [VET01] blamed the VA for his addiction to opioids by being over-prescribed painkillers. Although recent research claims a decline in long-term prescription opioid use [ 38 ], opioids have long been over-prescribed for recovery after surgical procedures [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Perspectives of homeless veterans living with substance use disorders (SUD) and mental illness

Betancourt,

Goldberg,

Hawks

et al. 2023

Heliyon

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“…An important limitation of our study is that the consumption patterns of opioid-exposed patients were not examined. This is a pervasive problem in surgical opioid literature: most existing post-surgical opioid prescribing research applies to opioid-naive patients only 15 , 23 . Treating the post-surgical pain of opioid-exposed patients is a space largely left up to clinical intuition.…”

Section: Discussionmentioning

confidence: 99%

“…This is a pervasive problem in surgical opioid literature: most existing post-surgical opioid prescribing research applies to opioid-naive patients only. 15,23 Treating the postsurgical pain of opioid-exposed patients is a space largely left up to clinical intuition. Moreover, while our results undoubtedly expose potential areas of under-prescribing, some findings of the current study, including procedure-specific patterns, may not be generalizable to all patient populations, as the current study utilizes consumption data from a single institution.…”

Section: Limitationsmentioning

confidence: 99%

Evaluation of U.S. State Opioid Prescribing Restrictions Using Patient Opioid Consumption Patterns from a Single, Urban, Academic Institution

et al. 2022

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Background:Since 2017, states, insurers, and pharmacies have placed blanket limits on the duration and quantity of opioid prescriptions. In many states, overlapping duration and daily dose limits yield maximum prescription limits of 150–350 morphine milligram equivalents (MMEs). There is limited knowledge of how these restrictions compare with actual patient opioid consumption; while changes in prescription patterns and opioid misuse rates have been studied, these are, at best, weak proxies for actual pain control consumption. We sought to determine how patients undergoing surgery would be affected by opioid prescribing restrictions using actual patient opioid consumption data. Methods: We constructed a prospective database of post-discharge opioid consumption: patients undergoing surgery at one institution were called after discharge to collect opioid consumption data. Patients whose opioid consumption exceeded 150 and 350 MME were identified. Results: Two thousand nine hundred and seventy-one patients undergoing 54 common surgical procedures were included in our study. Twenty-one percent of patients consumed more than the 150 MME limit. Only 7% of patients consumed above the 350 MME limit. Typical (non-outlier) opioid consumption, defined as less than the 75th percentile of consumption for any given procedure, exceeded the 150 MME and 350 MME limits for 41 and 7% of procedures, respectively. Orthopedic, spinal/neurosurgical, and complex abdominal procedures most commonly exceeded these limits. Conclusions: While most patients undergoing surgery are unaffected by recent blanket prescribing limits, those undergoing a specific subset of procedures are likely to require more opioids than the restrictions permit; providers should be aware that these patients may require a refill to adequately control post-surgical pain. Real consumption data should be used to guide these restrictions and inform future interventions so the risk of worsened pain control (and its troublesome effects on opioid misuse) is minimized. Procedure-specific prescribing limits may be one approach to prevent misuse, while also optimizing post-operative pain control.

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Treading the tightrope of opioid restrictions

Abstract: Efforts to restrict opioid prescriptions in the United States are having unintended effects on people with chronic pain.

Cited by 8 publications

References 11 publications

Trends and patterns in the use of opioids among metastatic breast cancer patients

Trends and patterns in the use of opioids among metastatic breast cancer patients

Perspectives of homeless veterans living with substance use disorders (SUD) and mental illness

Evaluation of U.S. State Opioid Prescribing Restrictions Using Patient Opioid Consumption Patterns from a Single, Urban, Academic Institution

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