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Michigan OPEN

Our Evidence

Michigan OPEN is driven by data and evidence. Our Prescribing Recommendations and all of our educational materials are shaped by our team’s research and published papers.

Healthcare Professionals

We support you with evidence-based practices, opioid prescribing recommendations, and more.

Healthcare Professionals

High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults

Vargas GM; Gunaseelan V; Upp L; Deans KJ; Minneci PC; Gadepalli SK; Englesbe MJ; Waljee JF; Harbaugh CM. High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults. Annals of Surgery. Published online 27 August 2021. DOI: 10.1097/SLA.0000000000005193
  • 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%).

New persistent opioid use after surgery in patients with a history of remote opioid use

Agarwal S, Shah A, Gunaseelan V, Sulich C, McAfee J, Urquhart AG, As-Sanie S, Lin J, Waljee JF, Brummett CM. New persistent opioid use after surgery in patients with a history of remote opioid use. Surgery Journal. Published online 8 December 2021. DOI: 10.1016/j.surg.2021.11.008
  • 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

Association of State Opioid Prescription Duration Limits With Changes in Opioid Prescribing for Medicare Beneficiaries

Cramer JD, Gunaseelan V, Hu HM, Bicket MC, Waljee JF, Brenner MJ. Association of State Opioid Prescription Duration Limits With Changes in Opioid Prescribing for Medicare Beneficiaries. Journal of the American Medical Association Internal Medicine. Published online 9 August 2021. DOI: 10.1001/jamainternmed.2021.4281
  • 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.

Effect of injury location and severity on opioid use after trauma

Baker RC, Brown CS, Montgomery JR, Mouch CA, Kenney BC, Englesbe MJ, Waljee JF, Hemmila MR. Effect of injury location and severity on opioid use after trauma. The Journal of Trauma and Acute Care Surgery. Published online 1 July 2021. DOI: 10.1097/TA.0000000000003138
  • 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.

Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgery

Brown CS; Osborne NH; Hu HM; Coleman D; Englesbe MJ; Waljee JF; Brummett CM; Vemuri C. Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgery. Vascular. Published online 15 June 2021. DOI: 10.1177/17085381211024514
  • 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.

The Association of Postoperative Opioid Prescriptions with Patient Outcomes

Howard, R; Brown, CS; Lai, YL; Gunaseelan, V; Chua, KP; Brummett, C; Englesbe, M; Waljee, J; Bicket, MC. The Association of Postoperative Opioid Prescriptions with Patient Outcomes. Annals of Surgery. Published online 4 June 2021. DOI: 10.1097/SLA.0000000000004965
  • Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids.
  • This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.

The Impact of Complications and Pain on Patient Satisfaction

Berkowitz R, Vu J, Brummett C, Waljee J, Englesbe M, Howard R. The Impact of Complications and Pain on Patient Satisfaction. Annals of Surgery. Published online 1 June 2021. DOI: 10.1097/SLA.0000000000003621
  • The predicted probability of being highly satisfied after surgery was 79% for patients who had no complications and 88% for patients who had no pain.
  • Patients who experienced postoperative complications and pain were less likely to be highly satisfied or have no regret.
  • Notably, postoperative pain has a more significant effect on satisfaction and regret after surgery, suggesting focused postsurgical pain management is an opportunity to substantially improve patient experiences.

A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency

Cho HE, Billig JI, Byrnes ME, Nasser JS, Kocheril AP, Haase SC, Waljee JF, Chung KC. A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency. Plastic and Reconstructive Surgery. Published online 1 May 2021. DOI: 10.1097/PRS.0000000000007841
  • Participants actively sought out protective mechanisms supporting their decision on opioid use, but sometimes did so unconsciously. Participants integrated a strong sense of self in their decision-making processes.
  • A robust understanding of how patients choose to take opioids for postoperative pain control is imperative to develop patient-centered strategies to treat the opioid epidemic.
  • Effective opioid-reduction policies should consider patients as active agents who negotiate various internal and external influences in their decision-making processes.

Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families

Chua KP, Kenney BC, Waljee JF, Brummett CM, Nalliah RP. Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families. American Journal of Preventive Medicine. Published online 29 April 2021. DOI: 10.1016/j.amepre.2021.02.008
  • Initial opioid prescriptions after dental procedures were associated with a higher risk of opioid overdose in patients.
  • The magnitude of increased risk was greater in patients who were publicly insured and in patients who had mental health or substance use disorders. Among privately insured patients in family plans, initial opioid prescriptions after dental procedures were associated with a higher risk of overdose in patients’ family members.
  • These findings highlight the importance of avoiding unnecessary dental opioid prescribing.

Persistent Opioid Use After Ophthalmic Surgery in Opioid-Naïve Patients and Associated Risk Factors

Ung C; Yonekawa Y; Waljee JF; Gunaseelan V; Lai Y; Woodward MA. Persistent Opioid Use After Ophthalmic Surgery in Opioid-Naïve Patients and Associated Risk Factors. Ophthalmology. Published online 22 April 2021. DOI: https://doi.org/10.1016/j.ophtha.2021.04.021
  • Exposure to opioids in the perioperative period is associated with new persistent use in patients who were previously opioid-naïve. New persistent opioid use was higher in patients having an initial perioperative opioid fill (3.4%) than patients without an initial perioperative fill (0.6%).
  • After adjusting for patient characteristics, initial perioperative opioid fill was independently associated with an increased odds of new persistent use.
  • Surgeons should be aware of those risks to identify at-risk patients in the current national opioid crisis and minimize prescribing opioids when possible.
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