Opioids are commonly prescribed after both minor and major surgeries for pain management, and many patients receive their first exposure to opioids following surgery.
Prescribers have little guidance available on opioids, and overprescribing is a widespread problem that contributes to the opioid epidemic currently claiming 130 American lives every day.*
With up to 92% of patients having leftover opioids after common operations, millions of pills are left vulnerable to diversion into communities.**
Takeaways from our research on opioid prescribing after surgey
- Becoming a new chronic opioid user is the most common post-surgical complication
- Prescribing often far exceeds pain management needs
- Prescription size is the strongest predictor of how much opioid a person will use
Ways to reduce risk associated with opioid prescribing after surgery
Prescribing Recommendations
Implementing evidence-based, operation-specific opioid prescribing recommendations can help to eliminate overprescribing.
Transitions of Care
Improving care coordination between surgeons and primary care providers could lead to earlier identification of patients at risk for new chronic use.
Disposal
Having a variety of methods for patients to dispose of leftover opioids can decrease opportunities for diversion and misuse.
Evidence-based policies are needed to improve opioid prescribing after surgery
Our research indicates that hospitals should develop protocols for opioid prescribing and disposal that include:
- Adopting evidence-based, operation-specific opioid prescribing guidelines.
- Standardizing the procedure for communication between surgeons and primary care providers to coordinate patients’ pain management and better identify patients at risk for new persistent opioid use. This procedure should both identify the method of communication and assign responsibilities to the primary care provider and the surgeon.
- Registering with the DEA to accept opioids for disposal to provide patients with more accessible methods for disposing of their unused medications.
*Opioid Overdose: Drug Overdose Deaths.Centers for Disease Control and Prevention. [updated 2018 Dec 19; cited 2019 Feb. 13]. Available from: www.cdc.gov/drugoverdose/data/ statedeaths.html
**Prescription opioid analgesics commonly unused after surgery: a systematic review. Bicket, M.C., Long, J.J., Pronovost, P.J., Alexander, G.C., Wu, C.L. (2017). JAMA Surgery, 152(11), 1066-1071. PMID: 28768328 doi:10.1001/jamasurg.2017. 0831
Download Michigan OPEN's procedure-specific prescribing recommendations
Association of opioid prescribing with opioid consumption after surgery in Michigan. Howard, R., Fry, B., Gunaseelan, V., Lee, J., Waljee, J., Brummett, C., Campbell, D., Seese, E., Englesbe, M., & Vu, J. (2018). JAMA Surgery. PMID: 30422239 doi:10.1001/jamasurg.2018.4234
Spillover effect of evidence-based postoperative opioid prescribing. Howard, R., Alameddine, M., Klueh, M., Englesbe, M., Brummett, C., Waljee, J., Lee, J. (2018). Journal of the American College of Surgeons, 227(3), 374-381. PMID: 30056059 doi:10.1016/j.jamcollsurg.2018.06.007
Patterns of initial opioid prescribing to opioid-naive patients. Larach, D.B., Waljee, J.F., Hu, H.M., Lee, J.S., Nalliah, R., Englesbe, M.J., Brummett, C.M. (2018). Annals of Surgery. PMID: 30048311 doi:10.1097/SLA.0000000000002969. [Epub ahead of print]
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: A retrospective review. Klueh, M.P., Hu, H.M., Howard, R.A., Vu, J.V., Harbaugh, C.M., Lagisetty, P.A., Brummett, C.M., Englesbe, M.J., Waljee, J.F., & Lee, J.S. (2018). Journal of General Internal Medicine, 33(10), 1685-1691. PMID: 29948809 doi:10.1007/s11606-018-4463-1.
Reduction in opioid prescribing through evidence-based prescribing guidelines. Howard, R., Waljee, J., Brummett, C., Englesbe, M.J., & Lee, J.S. (2018). JAMA Surgery, 153(3), 285-287. PMID: 29214318 doi:10.1001/jamasurg.20174436
New persistent opioid use after minor and major surgical procedures in US adults. Brummett, C.M., Waljee, J.F., Goesling, J., Moser, S., Lin, P., Englesbe, M.J., Bohnert, A.S.B., & Nallamothu, B.K. (2017). JAMA Surgery, 152(6):e170504. PMID: 28403427 doi:10.1001/jamasurg.2017.0504
IHPI members whose work is featured in this brief
Jennifer Waljee, M.D., M.P.H., M.S.