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Michigan OPEN
Michigan OPEN
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OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.

Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018

Chua KP; Hu HM; Waljee JF; Brummett CM; Nalliah RP. Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018. JADA. Published online 23 February 2021. DOI: https://doi.org/10.1016/j.adaj.2021.01.001
  • Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of total prescriptions; 
  • Tooth extraction accounted for ⅘ of prescriptions for adolescents and young adults and ⅗ of prescriptions for adults aged 26 through 64 years. 
  • In 2018, 45.3% of tooth extractions resulted in 1 or more initial prescriptions

Association of Postoperative Opioid Prescription Size and Patient Satisfaction

Fry BT; Howard RA; Gunaseelan V; Lee JS; Waljee JF; Englesbe MJ; Vu JV. Association of Postoperative Opioid Prescription Size and Patient Satisfaction. Annals of Surgery. Published online 1 February 2021. DOI: 10.1097/SLA.0000000000004784
  • No significant association between opioid prescription size and satisfaction 
  • 83% of patients receiving the smallest opioid prescription (25 mg OME) were satisfied compared to 85% of patients receiving the largest opioid prescription size (750 mg OME) 

Eliminating Unnecessary Opioid Exposure After Common Children’s Surgeries

Harbaugh CM, Vargas G, Streur CS, et al. Eliminating Unnecessary Opioid Exposure After Common Children's Surgeries. JAMA Surg. 2019;154(12):1154-1155. doi:10.1001/jamasurg.2019.2529
  • A discharge opioid was prescribed to 22% of 675 children younger than 18 years 
    • Median 10 doses (25th to 75th percentile, 6-15) 
  • Circumcision, elbow fracture, and orchiopexy had the highest opioid use; yet only 1 in 3 patients used an opioid, typically for 3 days or less.
  • Overall, pain control was reported as good among 82% of children with or without a discharge opioid prescription.

Association of Opioid Prescribing with Opioid Consumption After Surgery in Michigan

Howard R, Fry B, Gunaseelan V, et al. Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan. JAMA Surg. 2019;154(1):e184234. doi:10.1001/jamasurg.2018.4234
  • Patients use only 27% of opioids prescribed to them 
  • Patients use an additional 5 pills for every 10 extra pills prescribed to them 
  • The quantity of opioid prescribed is associated with higher patient-reported opioid consumption
  • Greater association between prescription size and consumption than reported pain levels and consumption

Patterns of Initial Opioid Prescribing to Opioid-Naive Patients

Larach DB, Waljee JF, Hu HM, et al. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2020;271(2):290-295. doi:10.1097/SLA.0000000000002969
  • The proportion of initial prescriptions for surgery, emergency, and dental care increased by nearly 16% from 2010 to 2016.
  • Dental care prescribing saw the greatest growth, with a 68% increase, while surgical patients received the highest proportion of potent opioids (90.2%).

Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines

Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines. JAMA Surg. 2018;153(3):285-287. doi:10.1001/jamasurg.2017.4436
  • Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
  • Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
  • Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.

Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of Care

Anderson M; Hallway A; Brummett CM; Waljee JF; Englesbe MJ; Howard RA. Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of Care. JAMA Surgery. Published online 27 January 2021. DOI: 10.1001/jamasurg.2020.5646
  • Patients participating in an opioid-sparing postoperative pathway received and used fewer opioids but reported less pain and similar satisfaction compared with patients receiving standard of care.
  • In the opioid-sparing pathway, 36.8% of patients did not receive an opioid prescription compared with 0% of patients receiving standard of care.
  • Importantly, more patients in the opioid-sparing group received no opioid prescription, which avoids the risk of diversion into communities.

Relationship between initial opioid prescription size and likelihood of refill after spine surgery

Massie L, Gunaseelan V, Waljee J, Brummett C, Schwalb JM. Relationship between initial opioid prescription size and likelihood of refill after spine surgery. The Spine Journal. Published online 16 January 2021.DOI: https://doi.org/10.1016/j.spinee.2021.01.016
  • About 26.3% of opioid-naïve patients obtained refills of their opioid prescriptions within 30 days of surgery.
  • The likelihood of obtaining a refill was unchanged with the size of the initial perioperative prescription across procedure categories.
  • Patient factors associated with increased likelihood of refills included age 30 to 39 years, female gender, anxiety disorder, mood disorder, and history of alcohol/substance abuse.
  • For opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.

A national evaluation of opioid prescribing and persistent use after ambulatory anorectal surgery

Keller DS, Kenney BC, Harbaugh CM, Waljee JF, Brummett CM. A national evaluation of opioid prescribing and persistent use after ambulatory anorectal surgery. Surgery. Published Online 4 December 2020. DOI: https://doi.org/10.1016/j.surg.2020.11.006
  • Over 2% of ambulatory anorectal procedures develop new persistent opioid use.
  • Logistic regression found new persistent opioid use was associated with perioperative opioid fills, increased comorbidity, tobacco use, and pain disorders; there was no significant association with procedure performed.
  • Despite small annual reductions in opioid prescriptions, there has been little change in the amount prescribed.
  • This demonstrates a need to develop and disseminate best practices for anorectal surgery, focusing on eliminating unnecessary opioid prescribing.

Does Surgical Intensity Correlate With Opioid Prescribing? Classifying Common Surgical Procedures

Cho HE, Hu H, Gunaseelan V, Chen J, Englesbe MJ, Chung KC, Waljee JF. Does Surgical Intensity Correlate With Opioid Prescribing? Classifying Common Surgical Procedures. Ann Surg: July 24, 2020. Publish Ahead of Print doi: 10.1097/ SLA.0000000000004299
  • Surgical intensity, classified as 5 ordinal clusters – low, mid-low, mid, mid-high, and high, is positively associated with initial opioid prescribing and rates of refill.
  • Median amount of opioid prescribed increased as the cluster-order increased: 150 oral morphine equivalents (OME) for low-intensity, 225 OME for mid-intensity, and 300 OME for high-intensity surgeries.
  • Rates of refill increased as surgical intensity also increased, from 17.4% for low, 26.4% for mid, and 48.9% for high-intensity procedures.
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