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Patients Use Only a Fraction of Opioids Given After Surgery — But Prescription Size Affects Use

Many surgeons write prescriptions for opioid pain medications four times larger than what their patients will actually use after common operations, a new study shows.

And the size of that prescription may be the most important factor in how many opioid pills the patient will take – outweighing their pain scores, the intensity of their operation and personal factors, the research suggests.

The study, published in JAMA Surgery by a team from the University of Michigan that has studied many aspects of surgical opioids, highlights the importance of using real-world information about surgical patient opioid use to guide prescribing. It also points to a need to provide options for surgical patients to dispose of unused opioids safely, so that the pills aren’t misused or lead to a poisoning or overdose.

The study used in-depth data from 2,392 patients who had one of 12 different common operations at 33 Michigan hospitals. On average, patients took only 27 percent of all opioids prescribed to them. But for every 10 additional pills prescribed, patients took five of them.

“It’s striking to see the major discrepancy between prescribed amount and the amount patients actually take,” says Joceline Vu, M.D., surgical resident at Michigan Medicine and Michigan OPEN research fellow.

“This is not a phenomenon of a few outlier surgeons – it was seen across the state, and across many operations.”

Ryan Howard, M.D., surgical resident, adds, “In what we tell patients about what kind of pain to expect after surgery, and how many pills we give, we set their expectations — and what the patient expects plays a huge role in their post-operative pain experience. So if they get 60 pain pills, they think they have to take many of them.”

Vu and Howard note that psychology research has dubbed this the anchoring and adjustment heuristic, where the baseline data someone receives – the size of a plate of food, for instance – makes a difference in how much they consume.

The median number of pills patients received was 30 – but the median number used was nine. The number of pills a patient received was the strongest predictive factor of the number they used. The next strongest was the patient’s self-reported memory of whether they had no pain, or moderate or severe pain in their first week after surgery: those who said they had severe pain took 16 more opioid pills than those with no pain.

Howard says, “We hope that by shining a spotlight on the difference between prescription size and actual use, we can empower surgeons to change their prescribing habits, and be a better steward to both their patient and the broader community.”