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Smaller scrips for opioids linked to lower consumption

Quantity of opioids prescribed post-surgery even more strongly linked to higher patient use than pain level

Louise Prime

Thursday, 08 November 2018

The quantity of opioids prescribed after surgery was the factor most strongly associated with patients’ opioid consumption – even more so than their reported level of pain – US research has revealed. The authors of the study,* published in JAMA Surgery, found that patients used an additional five pills for every 10 extra pills prescribed, and they said using patient-reported opioid consumption to develop better prescribing practices would be an important step in combating the opioid epidemic.

Researchers from the University of Michigan, Ann Arbor, pointed out that there is growing evidence that opioids are overprescribed following surgery; and improving prescribing practices means that we need to understand the factors associated with opioid consumption. They designed a retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults at least 18 years old who were undergoing surgery and who were prescribed an opioid after that surgery.

During the 10-month study period in 2017, 2,392 patients (mean age, 55 years; 1,353 women) underwent one of 12 surgical procedures. The research team compared opioid prescription size in these patients’ initial postoperative prescription, with patient-reported opioid consumption, in oral morphine equivalents.

Overall, patients reported using only 27% of prescribed opioids; the median quantity prescribed was 30 pills of hydrocodone/paracetamol (5/325mg), compared with nine pills used. The quantity of opioid that patients said they took varied widely, and was affected by several factors.

Patient-reported pain in the first week post-surgery was, unsurprisingly, significantly associated with opioid consumption – patients used a mean of nine more pills if they had moderate pain, and 16 more pills if they had severe pain, compared with patients reporting no pain. But the quantity of opioid prescribed was even more strongly associated with patient-reported opioid consumption, with patients using 0.53 more pills for every additional pill prescribed.

The researchers found that other influential factors significantly associated with increasing opioid use included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After they adjusted for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean opioid consumption compared with patients in the highest quintile (five pills vs. 37 pills).

They acknowledged that recall bias could be a limiting factor in their study, as patients might not have had accurate recollection of how many pills they took.

They commented: “The quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.”

* Howard R, Fry B, Gunaseelan V, et al. Association of opioid prescribing with opioid consumption after surgery in Michigan. JAMA Surg. Published online November 7, 2018. doi:10.1001/jamasurg.2018.4234.

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