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Cutting Postoperative Opioid Prescriptions Dramatically, With No Increase in Pain

A new study, published in JAMA Surgery, reveals an interesting breakthrough from the Michigan OPEN team at the University of Michigan, in efforts to stop the national crisis of opioid addiction. The study found that reducing opioid prescribing by nearly sixty-six percent did not affect the patient’s level of postoperative pain control, which would mean less opioids left over to be pushed into potential diversion.

Currently, no national guidelines exist for surgery-related pain control with opioids. The idea of creating guidelines on prescribing surgery-related pain prescriptions focuses on how patients actually use the medications, and then educating providers and the rest of the community based on this research.This study will provide evidence to support such guidelines.

The study reveals insight on post-op opiate use for a common operation: gallbladder removal. Patients undergoing this surgery receive an average prescription of 250 milligrams of opioids for the treatment of post-op pain. After interviewing a large portion of the patients, the researchers discovered that most of the patients used an average of 30 milligrams after their surgery. Many patients interviewed before the guidelines took effect said they wanted to know how many pills to expect to take, and the guide laid it out: “Most patients take about five or fewer, and they stop taking pain medicine by the fifth day after surgery”, one-fifth of what the average patient is prescribed!

As a result of these findings, Michigan Medicine lowered the average prescription given to their patients for gallbladder surgery to 75 milligrams of opioids (approximately 15 pills) in the 200 patients treated in the first five months after the guideline went into effect. Requests for opioid refills did not increase and the percentage of patients getting a prescription for nonopioid painkillers such as acetaminophen or ibuprofen more than doubled. These findings contribute to and support the recommendations created by Michigan OPEN and MSQC earlier this year.