Excess Opioids Often Prescribed After Hip and Knee Replacement Surgery: Study

The findings of new research suggest that a lack of effective protocols are leading to uneven prescribing patterns for opioids following knee and hip replacement surgery. 

Researchers with Dartmouth Hitchcock Medical Center published a study in the Journal of Bone & Joint Surgery on February 7, looking at prescribing patterns of opioids among orthopedic surgery patients, including how they used the widely abused drugs and whether they used all of them.

The study involved a review of prescribing data from 1,199 procedures, and phone interviews from 557 patients, seeking to determine the number of postoperative opioid pill prescriptions and the number of unused pills. The data came from patients who underwent hip replacement surgery, knee replacement surgery, endoscopic carpal tunnel release, arthroscopic rotator cuff repair or lumbar decompression at the medical center in 2015.

According to the findings, there was wide variation in prescribing patterns of opioids given to patients who underwent the five procedures for pain management. The mean number of oxycodone 5-mg equivalent opioid pills given for hip implant surgery and knee implant surgery was 90 pills, according to the study. However, a mean of only 20 pills were given for carpel tunnel procedures, 80 pills for rotator cuff repair, and 80 for lumbar decompression.

But those numbers showed a wide amount of variability, with ranges of 20 to 330 pills for total hip arthroplasty, for example. Some carpal tunnel patients were given no opioids, while others were given as many as 168 pills.

The study also found that 61% of patients reported not using all of their pills, and the study found that there were more than 43,000 unused opioid pills prescribed during just one year, with only 41% of patients reporting disposing of them properly. That leaves thousands of opioid pills which could get into the hands of drug dealers and addicts.

“Prescribing patterns vary widely, and a large amount of opioid medications remains unused following elective orthopaedic surgical procedures,” the researchers concluded. “Effective prescribing protocols are needed to limit this source of potential abuse and opioid diversion within the community.”

A study published earlier in January indicated nearly half of all patients prescribed opioids don’t need them for pain relief.

Nearly 12 million Americans misused prescription opioids in the past year. More than 40 people die every day from overdoses involving prescription opioids. In fact, opioid deaths now outnumber breast cancer fatalities each year.

Research published last year concluded people treated in ERs and given opioids are less likely to abuse them because they are given lower doses for shorter periods of time. These factors appear to weigh heavily on whether a patient becomes addicted to the substances.

As opioid abuse problems continue to worsen, the U.S. Centers for Disease Control and Prevention warns death rates due to the opioid crisis may be worse than estimated and opioid abuse problems remain widely underreported.