Philadelphia—Pharmacists probably suspected that opioid painkiller prescriptions were becoming more routine for patients undergoing common surgeries, and now, a new study provides data to back that up.
For the study published online recently by JAMA, University of Pennsylvania and University of Toronto researchers analyzed insurance claims from 2004 through 2012 for 155,297 adults undergoing four common outpatient surgeries—carpal tunnel repair, laparoscopic gall bladder removal, some minimally invasive knee surgeries, and hernia repair. In an analysis of patients who had not received an opioid prescription in the 6 months preceding surgery, the researchers determined that four out of five filled a prescription for an opioid pain medication within the 7 days after surgery, with the percentage of patients prescribed those painkillers increasing for all four procedures over the study period.
Over time, patients receiving the drugs were more likely to be older and male and less likely to have had inpatient surgery. Within 7 days, 80.0% filled a prescription for any opioid, and 86.4% of these prescriptions were for hydrocodone/acetaminophen or oxycodone/acetaminophen. The study notes that the proportion filling a prescription for hydrocodone/acetaminophen or oxycodone/acetaminophen varied across surgical procedures from 59.7% for carpal tunnel release to 75.5% for inguinal hernia repair.
In addition, the amount of opioid medication dispensed to patients after surgery also increased significantly between 2004 and 2012 for all procedures studied. Study authors estimate a more than 18% increase in the average total amount of opioids dispensed, based on the average daily dose, among patients undergoing knee arthroscopy.
“These data show us a concerning trend,” senior author Mark Neuman, MD, MSc, said in a University of Pennsylvania press release. “The growth we observe over time in opioid prescribing after surgery occurs against the backdrop of a major public health crisis of prescription opioid abuse. Additional work is needed to understand how postoperative opioid prescribing patterns might play into this epidemic, and to define better strategies for treating postoperative pain safely and effectively in the future.”
The research was published about at the same time as a major new guideline from the CDC. It calls on physicians to avoid over-prescription of opioids for surgical patients and other patients with painful conditions.
A special communication from the CDC, published in JAMA, addresses pain management outside of active cancer treatment, palliative care, and end-of-life care. Nonopioid therapy is recommended for the treatment of chronic pain, with opioids reserved for situations where the benefits for pain and function are expected to outweigh the risks, according to the document.
The guidelines also recommend that clinicians establish treatment goals before prescribing opioids and address how opioids can be discontinued if benefits do not outweigh risks. In addition, the CDC recommends that clinicians prescribe the lowest effective dose; carefully reassess benefits and risks when considering increasing dosage; and evaluate the benefits and harms of continued opioid therapy with patients every 3 months or more frequently for high-risk combinations or dosages.
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