Publications

• In 2016, 8485 (0.6%) of the 1.5 million opioid prescriptions filled by US adults and children with family insurance plans occurred when at least 1 family member met criteria for prescriber and pharmacy shopping. *
• Among the 8485 index fills, 68.1% of prescribing clinicians were physicians, 7.9% were physician assistants, 7.2% were nurse practitioners, and 43% were dentists.
• The most common physician specialties among the 8485 index fills were family medicine (17.1%), pain medicine (16.4%), internal medicine (9.6%), and orthopedic surgery (6.5%)

*prescriber and pharmacy shopping is when an individual obtains opioids from high numbers of prescribers and pharmacies

• 60.4% of caregivers reported storage education despite only 18.3% keeping the opioids in locked storage. Caregivers who reported verbal and/or written storage education were more likely to lock opioids in storage
• Of the 606 caregivers surveyed, 451 (74%) had leftover opioids. Of the 451, only half (50.1%) reported disposal education and a quarter (24.6%) disposed of the excess opioids. 
• There was no association between leftover opioid disposal and verbal and/or written disposal education.

• 56% of families who only received standard postoperative discharge instructions on opioid safety reported proper opioid disposal compared to 72% of families who received a drug disposal bag and the standard postoperative discharge instructions.
• 20% increase in the rate of proper opioid disposal with the provision of a drug disposal bag. 
• Higher than expected rate of opioid disposal among families that did not receive a disposal bag suggests that standardized, multimodal, opioid related education provided to families of surgical patients does impact disposal rates.

• More than 140 providers were trained in the use of medications for OUD in acute care settings.
• A total of 872 naloxone rescue kits were distributed to ED patients at risk of opioid overdose during the first phase of this project.
• A statewide ED take-home naloxone program was shown to be feasible across a range of different hospitals with varying maturity in preexisting OUD resources and capabilities.

• Opioid-related morbidity and mortality have dramatically increased in the United States over the last several decades.
• Opioid prescribing after surgery has often been in excess, in part owing to the absence of clear prescribing guidelines based on patient-reported pain and opioid-related outcomes.
• Disposal of excess pills after surgery remains low, and unused opioid pills are an important contributor to the opioid epidemic owing to diversion and misuse.

• High-risk opioid prescribing practices increased from 34.9% to 43.5% in opioid-naïve patients aged 13-21 from 2008 to 2016; the largest increase was in co-prescribed benzodiazepines (24.1% to 33.4%).
• High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients’ risk of persistent opioid use.
• Most opioid prescriptions to patients with persistent use beyond the postoperative period were from non-surgical prescribers (79.6%).

• Among patients not using opioids preoperatively, a history of opioid use was independently associated with new persistent opioid use after surgery, especially those with a history of continuous opioid use.
• Similarly, history of opioid use was independently associated with opioid prescription refill at 1 month after surgery.
• Moderate to high alcohol use was associated with new persistent use as well as opioid prescription refill at 1 month

• Between March 2016 and July 2018, 23 states implemented legislation limiting the duration of initial opioid prescriptions to a maximum of 7 days (17 states limited to 7 days or less, 2 states to 5 days or less, and 4 states to 3 days or less).
• State laws limiting opioid prescriptions to 7 day or less were associated with a reduction in opioid prescribing by 1.7 days per enrollee.
• The state legislation on opioid prescribing primarily targets initial opioid prescriptions provided for acute pain, and we observed decreases that were most pronounced among surgeons and dentists.

• Among patients admitted for traumatic injury, 8.6% developed new persistent opioid use.
• Patients suffering from extremity and abdominal injuries are at highest risk.
• Maximum individual region injury severity predicts development of new persistent use, whereas total injury severity does not.

• Among opioid-naïve patients undergoing vascular surgery procedures in Medicare between 2009 and 2017, 2.6% of all patients developed new persistent use.
• Undergoing endovascular carotid or venous surgery was associated with an increased risk of NPOU, whereas no differences were found between endovascular and open approaches for peripheral arterial or aortic disease.