YOUR PRESCRIPTION MAKES A DIFFERENCE

We developed the Opioid Prescribing Recommendations to empower you to provide great tailored care to your patients. A preventative, evidence-based approach, these recommendations comprise best practices in acute care settings to help reduce your patient’s risk of developing persistent opioid use – without compromising well-being during recovery.

Since the launch of the recommendations in Michigan, prescription size has been reduced by 76% with no change in patient-reported pain or satisfaction scores.

Considerations:

• 6-10% of opioid-naive patients undergoing common surgical procedures continue filling opioid prescriptions 3-6 months after surgery.¹ ²
• 92% of opioids prescribed by surgeons go unused by patients.²

USING THE RECOMMENDATIONS IN YOUR PRACTICE

When an opioid is needed after surgery, use the OPEN prescribing recommendations as the foundation for a shared decision-making conversation with the patient to determine the best prescription size.

It’s important to note that these are not rigid rules that must be adhered to, but rather recommendations. Starting form a standardized approach and then allowing for individualization helps promote both equity and patient-centeredness.

1. Determine the opioid prescribing range based on:
   • Type of procedure
   • Additional procedures performed
2. With the patient, determine the best prescription size within the appropriate range
   • Assess for individual risk factors
   • Consider patient preferences and other non-opioid strategies utilized
   • Pain management at the time of discharge:
     • Pain scores in 24 hours prior to discharge
     • Medication use in 24 hours prior to discharge
     • Timing of discharge

Adult Opioid Prescribing Recommendations

Our adult Opioid Prescribing Recommendations are designed for patients with no preoperative opioid use and are notintended for patients taking opioids preoperatively.

Along with published studies and expert consensus, our recommendations are informed by patient-reported outcomes (PROs) on opioid consumptions, pain control, and satisfaction. The levels of evidence used to draw conclusions about opioid prescribing are clearly outlined, so providers can make educated determinations about prescribing and care – while taking individual patient needs into consideration.

Adult Prescribing Recommendations

Pediatric Opioid Prescribing Recommendations

Our pediatric Opioid Prescribing Recommendations are designed for pediatric patients with no preoperative opioid use and are not intended for patients taking opioids preoperatively.

OPEN developed these recommendations for opioid prescribing after pediatric surgery (<18 years old) based on patient-reported outcomes (PROs) on opioid consumption, pain control and patient satisfaction, published studies, and expert consensus. Pain Score was rated on a scale of 1 (no pain) to 5 (worst possible pain). Satisfaction with Pain Management was rated on a scale of 1 (not at all satisfied) to 5 (very satisfied).

• Recommendations are provided in doses to account for variations in dosing by weight.
• For liquid medication, consult your pharmacy for minimum volume requirements before prescribing at the recommended doses for children with low body weight.
• To learn more about caring for pediatric pain after surgery and to access tools for providers and families on pain management, visit our Pediatrics page

Pediatric Prescribing Recommendations

References:

1. Hill M, McMahon ML, Stucke RS, Barth RJ Jr. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714.
2. Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017;152(11):1066-1071.
3. 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.

Cite this work:

OPEN: Overdose Prevention Engagement Network (2024). OPEN Prescribing Recommendations- Adult. Retrieved from https://doi.org/10.56137/OPEN.000054

OPEN: Overdose Prevention Engagement Network (2024).  OPEN Prescribing Recommendations – Pediatric. Retrieved from https://doi.org/10.56137/OPEN.000055

OPEN: Overdose Prevention Engagement Network (2024). Pain and Opioid Data Collection Recommendations. Retrieved from https://doi.org/10.56137/OPEN.000076