opioid prescriptions

A new study published in JAMA Surgery determines whether the current seven-day limit on opioid prescriptions following surgery is adequate for all patients.

Opioids are a class of drugs that have proven effective in pain relief and are considered safe when prescribed for short periods of time under the supervision of a doctor. However, there is currently an epidemic in society in the misuse and overuse of these medications, resulting in abuse and dependency. One informational issue that is a potential contributing factor in this opioid epidemic is the uncertainty around the optimal length of time that opioid prescriptions should be prescribed for, particularly to alleviate post-surgical pain.

JAMA Surgery recently reported a valuable study that uncovered some rough guidelines for the optimum length of opioid prescriptions, categorized by surgery type. This American study used data from the Military Health System Data Repository and the TRICARE Insurance program.

The study looked at patients between 18 and 64 years of age, who had undergone one of eight common surgical procedures, namely cholecystectomy, appendectomy inguinal hernia repair, anterior cruciate ligament reconstruction, rotator cuff tear repair, discectomy, mastectomy, and hysterectomy. The study was long-term (surgeries between January 1, 2005, and September 14, 2014), and comprised a large number of patients (215,140).  The large number of patients in this study was considered by the authors to be representative of the population of the United States.

The main measure that the study authors used to determine if the opioid prescription duration for these patients was effective was whether or not the patients required a refill of their prescription. The need for a refill (defined as a repeat prescription within 14 days of the end date of the original prescription) would indicate that the initial opioid prescription was not long enough.

The authors discovered that while the patients studied were given opioid prescriptions within the seven-day limit, the optimal post-surgery opioid prescription length may be much higher. Specifically, the authors recommended four to nine days for general surgery procedures, four to thirteen days for women’s health procedures, and six to fifteen days for musculoskeletal procedures. The authors recommended that opioid prescription lengths be extended to ten days, especially after neurosurgical and musculoskeletal (e.g. orthopedic) surgeries.

There were also limitations to this study. For example, rates of unused prescriptions were not captured. As well, use by the patients of non-opioid medications to alleviate their pain, such as acetaminophen, which may have reduced their need for post-operative opioids, were not known.

The application of this study for physicians is that seven-day limits on post-operative opioid prescription lengths may be unnecessarily restrictive. Doctors need to balance the pain relief needs of their patients while ensuring against any overprescribing leading to dependence.

Written by Raymond Quan, MASc, MBA

Scully, Rebecca E., et al. “Defining Optimal Length of Opioid Pain Medication Prescription After Common Surgical Procedures” JAMA Surgery (September 27, 2017)

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