Restricted Opioid Prescribing May Reduce Chronic Use Post-Surgery

Prescribing a 3-day or fewer supply of opioids to patients who were discharged from the hospital after surgery is an effective way to treat acute pain and reduces the number of patients who chronically abuse opioids, according to a recent prospective cohort study.

Participants included in the study underwent surgery from August 2018 to July 2019 and were prescribed a restrictive post-surgical opioid prescription protocol (ROPP) of 3 days or fewer, along with education through a video before surgery to understand pain management expectations. The researchers used the rate of compliance with the ROPP and the number of patients with new, chronic opioid use as their main outcomes to measure the success of the study.

In total, 4068 patients were included in the study, and they were divided into two groups: pre-ROPP, unrestricted opioid use (n = 2017), and post-ROPP, restricted opioid use (n = 2051). In the first 6 months, the overall compliance rate with the ROPP was 95%. After implementing the ROPP treatment, the mean duration of opioid prescriptions decreased from 4.5 days in the pre-ROPP group to 3.6 days in the post-ROPP group. Additionally, patients in the post-ROPP group requested fewer opioid refills.

Overall, the ROPP led to a 45% decrease in opioids after surgery and continued during the post-study period.

The study limitations should be considered. Notably, the study was conducted using data from a single cancer center with results reflecting the western New York region. It is recommended by researchers that further research be conducted in other regions of the United States.

“Changes in established clinical practices can be a daunting prospect, and unlearning conventional, anecdotal wisdom may be difficult,” the researchers concluded. “Our findings suggest that success at reducing opioid prescribing on an institutional level is possible through interprofessional collaborations, simple guidelines, and regular feedback on performance to establish a high-quality postsurgical recovery strategy and may be associated with decreased risk for unintended, long-term complications from opioid use.”

Reference:

Zsiros E, Ricciuti J, Gallo S, et al. Postoperative restrictive opioid protocols and durable changes in opioid prescribing and chronic opioid use. JAMA Oncol. Published online January 5, 2023. doi:10.1001/jamaoncol.2022.6278