How many opioid pills do you need after surgery?

When Mark Greenberg had arthroscopic knee surgery in 2017 he was surprised he got a prescription for 50 pills of the pain reliever Percocet from a fellow doctor. Percocet contains oxycodone, an opioid commonly used to treat pain but has a high risk of addiction.

“I never filled the prescription,” says Dr. Greenberg says, a pain management physician in Ashland, Ore. “I certainly didn’t need any pain medications for a relatively painless surgical procedure.”

The pain specialist says he can see how some patients getting such a procedure might need 10 or 15 pills to get them through the first couple of days. But he found 50 excessive.

The opioid epidemic kills on average 115 Americans a day, according to the Centers for Disease Control and Prevention. About 40% of overdose deaths in the U.S. involve a prescription opioid.

Emergency room doctors, dentists and outpatient physicians are curbing prescriptions. And surgeons are rethinking their own prescription practices.

“We have so many opioids in our community,” says IHPI member Chad Brummett, an associate professor of anesthesiology at the University of Michigan and co-director of OPEN. “Drawing back to where that person got the prescription is not easy in many cases. You can assume more than half are for chronic pain conditions. But we think acute care is the most important opportunity for prevention.”

Dr. Brummett says studies have found that between 6% and 13% of patients not using opioids before surgery use them persistently three to six months later. But it’s a continuing area of research, and experts aren’t entirely clear on how many patients who first receive an opioid prescription after surgery become dependent or addicted to them.

In one study, Dr. Brummett and colleagues found that about 6% of patients who received opioids for a minor or major surgical procedure became new persistent users, defined as getting at least one opioid prescription 90 to 180 days after their procedure. They published their study in JAMA Surgery in June.

Those with mood disorders, alcohol and substance abuse disorders and chronic pain disorders showed a higher chance of becoming a persistent user. Smokers also faced a higher risk.