Dramatic Reduction in Opioid Prescribing for Common Outpatient Orthopaedic Lower Extremity Surgical Procedures at a Louisiana University-Based Safety-Net Hospital After Enactment of Opioid-Limiting State Legislation
Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders, including state legislatures, have attempted to curb opioid overprescribing to reduce related abuse/dependence, overdose deaths, and divers...
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Published in: | Journal of the American Academy of Orthopaedic Surgeons Vol. 30; no. 3; pp. e405 - e414 |
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Lippincott Williams & Wilkins
01-02-2022
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Abstract | Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders, including state legislatures, have attempted to curb opioid overprescribing to reduce related abuse/dependence, overdose deaths, and diversion. Objective: To examine trends in opioid prescribing for common outpatient lower extremity orthopaedic surgeries in a population vulnerable to prolonged opioid use before and after the enactment of a 2017 Louisiana state law limiting opioid prescribing for acute pain. Methods: Eligible patients were adults who underwent one of the five most common outpatient lower extremity orthopaedic surgeries done during 2013 to 2018 at an urban tertiary care academic medical center. Excluded were prisoners and patients who required inpatient hospitalization, had no documented discharge opioid prescription, or filled an opioid prescription unrelated to their orthopaedic procedure within 30 days before surgery. Results: During 2013 to 2018, 655 surgical procedures were done in 655 eligible patients, of whom 49% were Black and 54% were insured by Medicaid. The mean morphine milligram equivalent per discharge prescription decreased by almost 70% from 2014 to 2018. A statistically significant decrease in the mean morphine milligram equivalent per discharge prescription was observed in 2018 versus all previous years ( P < 0.0001 for all) and in 2017 versus all previous years ( P < 0.0001 for all). Patients receiving at least one new opioid prescription after their discharge prescription declined over time from a high of 50% in 2013 to a low of 19.3% in 2018 with a statistically significant effect over time ( P < 0.0001). Discussion: Opioid prescribing for patients undergoing common outpatient lower extremity orthopaedic surgeries who were at high risk for prolonged opioid use markedly declined after the enactment of a state law limiting first-time opioid prescriptions to 7 days, requiring physicians to check the state's Prescription Monitoring Program database and mandating continuing education for opioid prescribers. |
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AbstractList | INTRODUCTIONThe opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders, including state legislatures, have attempted to curb opioid overprescribing to reduce related abuse/dependence, overdose deaths, and diversion. OBJECTIVETo examine trends in opioid prescribing for common outpatient lower extremity orthopaedic surgeries in a population vulnerable to prolonged opioid use before and after the enactment of a 2017 Louisiana state law limiting opioid prescribing for acute pain. METHODSEligible patients were adults who underwent one of the five most common outpatient lower extremity orthopaedic surgeries done during 2013 to 2018 at an urban tertiary care academic medical center. Excluded were prisoners and patients who required inpatient hospitalization, had no documented discharge opioid prescription, or filled an opioid prescription unrelated to their orthopaedic procedure within 30 days before surgery. RESULTSDuring 2013 to 2018, 655 surgical procedures were done in 655 eligible patients, of whom 49% were Black and 54% were insured by Medicaid. The mean morphine milligram equivalent per discharge prescription decreased by almost 70% from 2014 to 2018. A statistically significant decrease in the mean morphine milligram equivalent per discharge prescription was observed in 2018 versus all previous years (P < 0.0001 for all) and in 2017 versus all previous years (P < 0.0001 for all). Patients receiving at least one new opioid prescription after their discharge prescription declined over time from a high of 50% in 2013 to a low of 19.3% in 2018 with a statistically significant effect over time (P < 0.0001). DISCUSSIONOpioid prescribing for patients undergoing common outpatient lower extremity orthopaedic surgeries who were at high risk for prolonged opioid use markedly declined after the enactment of a state law limiting first-time opioid prescriptions to 7 days, requiring physicians to check the state's Prescription Monitoring Program database and mandating continuing education for opioid prescribers. Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders, including state legislatures, have attempted to curb opioid overprescribing to reduce related abuse/dependence, overdose deaths, and diversion. Objective: To examine trends in opioid prescribing for common outpatient lower extremity orthopaedic surgeries in a population vulnerable to prolonged opioid use before and after the enactment of a 2017 Louisiana state law limiting opioid prescribing for acute pain. Methods: Eligible patients were adults who underwent one of the five most common outpatient lower extremity orthopaedic surgeries done during 2013 to 2018 at an urban tertiary care academic medical center. Excluded were prisoners and patients who required inpatient hospitalization, had no documented discharge opioid prescription, or filled an opioid prescription unrelated to their orthopaedic procedure within 30 days before surgery. Results: During 2013 to 2018, 655 surgical procedures were done in 655 eligible patients, of whom 49% were Black and 54% were insured by Medicaid. The mean morphine milligram equivalent per discharge prescription decreased by almost 70% from 2014 to 2018. A statistically significant decrease in the mean morphine milligram equivalent per discharge prescription was observed in 2018 versus all previous years ( P < 0.0001 for all) and in 2017 versus all previous years ( P < 0.0001 for all). Patients receiving at least one new opioid prescription after their discharge prescription declined over time from a high of 50% in 2013 to a low of 19.3% in 2018 with a statistically significant effect over time ( P < 0.0001). Discussion: Opioid prescribing for patients undergoing common outpatient lower extremity orthopaedic surgeries who were at high risk for prolonged opioid use markedly declined after the enactment of a state law limiting first-time opioid prescriptions to 7 days, requiring physicians to check the state's Prescription Monitoring Program database and mandating continuing education for opioid prescribers. |
Author | Kubilay, Tara Plessl, Daniel S. Morreale, Peter J. Bronstone, Amy B. Krause, Peter C. Tortorich, Gregory M. Leonardi, Claudia |
AuthorAffiliation | From the Department of Orthopaedics (Bronstone, Krause); the School of Public Health (Leonardi); the School of Medicine (Kubilay), LSU Health Sciences Center, New Orleans, LA, the Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (Plessl); the Department of Internal Medicine, School of Medicine, Washington University, St Louis, MO (Morreale), and the Department of Surgery, LSU Health Sciences Center, New Orleans, LA (Tortorich) |
AuthorAffiliation_xml | – name: From the Department of Orthopaedics (Bronstone, Krause); the School of Public Health (Leonardi); the School of Medicine (Kubilay), LSU Health Sciences Center, New Orleans, LA, the Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (Plessl); the Department of Internal Medicine, School of Medicine, Washington University, St Louis, MO (Morreale), and the Department of Surgery, LSU Health Sciences Center, New Orleans, LA (Tortorich) |
Author_xml | – sequence: 1 givenname: Amy B. surname: Bronstone fullname: Bronstone, Amy B. organization: From the Department of Orthopaedics (Bronstone, Krause); the School of Public Health (Leonardi); the School of Medicine (Kubilay), LSU Health Sciences Center, New Orleans, LA, the Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (Plessl); the Department of Internal Medicine, School of Medicine, Washington University, St Louis, MO (Morreale), and the Department of Surgery, LSU Health Sciences Center, New Orleans, LA (Tortorich) – sequence: 2 givenname: Claudia surname: Leonardi fullname: Leonardi, Claudia – sequence: 3 givenname: Tara surname: Kubilay fullname: Kubilay, Tara – sequence: 4 givenname: Daniel S. surname: Plessl fullname: Plessl, Daniel S. – sequence: 5 givenname: Peter J. surname: Morreale fullname: Morreale, Peter J. – sequence: 6 givenname: Gregory M. surname: Tortorich fullname: Tortorich, Gregory M. – sequence: 7 givenname: Peter C. surname: Krause fullname: Krause, Peter C. |
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References | Heins (R1-20240803) 2019; 109 Shah (R28-20240803) 2020; 36 Roof (R14-20240803) 2021; 34 Hsu (R16-20240803) 2019; 33 Volkow (R4-20240803) 2016; 374 Gaddis (R9-20240803) 2019; 270 Reid (R27-20240803) 2020; 478 Chapman (R8-20240803) 2020; 29 Carlos Rodriguez-Merchan (R15-20240803) 2019; 15 Waljee (R22-20240803) 2016; 137 Stepan (R34-20240803) 2019; 101 Tan (R36-20240803) 2020; 28 Ruddell (R10-20240803) 2021; 103 Lo (R35-20240803) 2020; 141 Volkow (R6-20240803) 2011; 305 Ukert (R13-20240803) 2020; 10 McDowell (R25-20240803) 2021; 44 Hoang (R32-20240803) 2020; 63 Guy (R5-20240803) 2018; 55 Lanzillotta-Rangeley (R29-20240803) 2020; 88 Reid (R26-20240803) 2020; 34 Lipof (R12-20240803) 2019; 42 Sheth (R7-20240803) 2020; 12 Yorkgitis (R33-20240803) 2018; 227 Wyles (R11-20240803) 2020; 5 Lott (R23-20240803) 2020; 28 Davis (R17-20240803) 2019; 194 Benfield (R24-20240803) 2020; 6 |
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Snippet | Introduction: The opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics.... INTRODUCTIONThe opioid epidemic in the United States has been fueled by overprescribing opioids, which is particularly apparent in orthopaedics. Stakeholders,... |
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