Study Finds Patients Don’t Use All Opioids When Excessively Prescribed
Many surgeons have long prescribed four times the amount of opioid pain medications patients will actually take after their operations, a new study published in JAMA Surgery by a team from the University of Michigan. And the size of that prescription may be the most important factor in how many opioid pills the patient will take. The study also illustrates a need to provide options for surgical patients to dispose of unused opioids safely. Having half-used pill bottles lying around means more opportunity for them to be misused.
The study used in-depth data from 2,392 patients who had one of 12 different common operations at 33 Michigan hospitals. On average, patients took only 27 percent of all opioids prescribed to them. However, the research team found that every ten additional pills, patients only took five.
The researchers used data from patients who had their operations last year at hospitals that participate in the Michigan Surgical Quality Collaborative (MSQC), and the study focuses on a time period after public awareness of the opioid epidemic, but before the launch of surgical opioid prescribing recommendations from the University of Michigan.
“It’s striking to see the major discrepancy between the prescribed amount and the amount patients actually take,” says Joceline Vu, M.D., senior author and a surgical resident and research fellow at Michigan Medicine, University of Michigan’s medical center. “This is not a phenomenon of a few outlier surgeons – it was seen across the state, and across many operations.”
Ryan Howard, M.D., the surgical resident and first author, adds, “In what we tell patients about what kind of pain to expect after surgery, and how many pills we give, we set their expectations – and what the patient expects plays a huge role in their post-operative pain experience. So, if they get 60 pain pills, they think they have to take many of them.”
Funded by Blue Cross Blue Shield of Michigan, MSQC provided a natural laboratory to study surgical opioid prescribing and use. In addition to tracking prescription information, MSQC worked with hospital staff to start a program of calling patients one month, then three months following surgeries to discuss pain medication use and overall pain levels. The median number of pills patients received was 30 – but the median number used was nine.
Twelve operations were assessed and patients who underwent hernia surgery used the most opioids while those who had their appendix or thyroid removed used the least.
They also didn’t have information on each patient’s prior prescriptions for opioids or use of opioids before surgery. The U-M team has previously shown that those who go into surgery already taking prescription opioids have worse outcomes and a higher likelihood of going on to prolonged use of opioids long after surgical pain should have diminished.
Howard says, “We hope that by shining a spotlight on the difference between prescription size and actual use, we can empower surgeons to change their prescribing habits, and be a better steward to both their patient and the broader community.”
Vu, Howard and their colleagues are working to update the surgical prescribing guidelines and hope to repeat the study in other patient populations.