Prescribing Program after Surgery May Help Reduce Opioid Prescriptions: Study

Guided prescribing programs for powerful pain medications may reduce the number of patients who become addicted to opioids in the future, according to the findings of a new study.

When doctors employed a program designed to curb opioid abuse and addiction, patients were more likely to be given painkillers for valid reasons, according to the findings of a study published last week in the Annals of Surgery.

Prior studies have indicated that about 5% to 10% of new opioid users prescribed painkillers after surgery will go on to receive long-term opioid prescriptions for 3 to 12 months after surgery. However, not much is known about the reasons why long-term prescriptions are given in these situations. Many fear long-term prescriptions may be fueling the opioid abuse epidemic, as nearly 70% of all overdose deaths in the U.S. now involve opioids.

In this latest study, researchers from Dartmouth-Hitchcock Medical Center evaluated data on 221 surgical patients who had never taken opioid painkillers and were enrolled in a clinical trial, which used patient-focused guidelines for opioid prescribing. Doctors followed specific guidelines to dictate who could receive opioid prescriptions and for how long.

Patients were treated for a wide variety of reasons, but the vast majority, 88%, underwent cancer-related surgeries involving significant pain levels. The need for long-term opioid prescriptions was determined using a Prescription Drug Monitoring Program search, and reasons for prescriptions and opioid adverse events were found using medical record review.

Persistent opioid use was defined during the study as prescriptions for three to 12 months after surgery and for more than a 60 day supply.

Overall, 15% of patients filled an opioid prescription three to 12 months after surgery. About 5% of patients filled prescriptions for three to six months and 12% of patients filled a prescription for six to 12 months following surgery.

A larger proportion of patients did fill prescriptions for a long-term period after surgery. Yet, researchers emphasized the majority of reasons for long-term painkiller use were legitimate and included chronic cancer pain. Additionally, a large number of patients ended up not needing most of their painkillers by the end of the study.

About half of patients, 51%, used long-term opioid prescriptions because they had a new painful medical condition. Comparatively, 40% of patients used painkillers because they had just undergone a new surgery, 6% said it was related to the index operation, and only one patient on one occasion was given an opioid prescription for a nonspecific reason.

The average opioid prescription was given for only seven days. While some patients were prescribed painkillers for up to 447 days, most patients used short rounds of painkillers. Using targeted prescribing guidelines helped to reduce painkiller over prescribing.

Among the patients studied, 2.3% developed persistent opioid use. This was the equivalent of five patients total. Two patients developed persistent use because they had developed chronic, recurrent cancer pain. Two patients developed new medical conditions and one patient suffered from a chronic abscess.

Prior studies have highlighted the need to curb prescriptions of painkillers like Vicodin for non-cancer pain. However, many doctors prescribe narcotic painkillers for unnecessary reasons such as conditions like Lupus and childhood tonsillectomies. Many ER doctors prescribe more opioids than they realize.

Prior research has also indicated doctor overprescribing is a leading factor of the worsening painkiller abuse epidemic. Doctors prescribe opioids at least 30% of the time without a documented pain diagnosis.

“In a group of prospectively studied opioid-naïve surgical patients discharged with guideline-directed opioid prescriptions and who achieved high rates of excess opioid disposal, no patients became persistent opioid users solely as a result of the opioid prescription given after their index surgery,” the researchers determined. “Long-term opioid use did occur for other, well-defined, medical or surgical reasons.”