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Michigan OPEN
Michigan OPEN
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Opioid Prescribing Recommendations

OPEN was founded in an effort to develop a preventive approach to the opioid epidemic by tailoring post-operative and acute care opioid prescribing. Our research has allowed us to create evidence-based prescribing guidelines based on the specific needs of each procedure. Since we’ve established these guidelines, opioid prescribing after surgery has declined by 50%.

Colon and Rectal Surgery
Oxycodone 5mg tablets*
0 - 10
0 - 15
0 - 15
0 - 15
Dentistry
Oxycodone 5mg tablets*
0
Nonsteroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications are as effective as opioids at controlling pain after dental extraction.Download PDF
General Surgery
Oxycodone 5mg tablets*
0 - 10
0 - 10
0 - 10
0 - 15
0 - 10
This recommendation was developed based on expert opinion, consensus and data from similar surgeries (see laparoscopic cholecystectomy and laparoscopic anti-reflux (NISSEN)). Quality improvement studies and prospective data collection is ongoing for future revisions.Download PDF
0 - 10
0 - 10
This recommendation was developed based on expert opinion, consensus and data from Michigan Pain Control Optimization Pathway. Prospective data collection is ongoing for future revisions.Download PDF
0 - 5
Surgical Oncology
Oxycodone 5mg tablets*
0 - 5
This recommendation was developed based on the following study:
https://www.ncbi.nlm.nih.gov/pubmed/30238243Download PDF
0 - 5
This recommendation was developed based on the following study:
https://www.ncbi.nlm.nih.gov/pubmed/30238243Download PDF
0 - 5
This recommendation was developed based on the following study:
https://www.ncbi.nlm.nih.gov/pubmed/30238243Download PDF
0 - 20
This recommendation was developed based on the following study:
https://www.ncbi.nlm.nih.gov/pubmed/30238243Download PDF
0 - 20
This recommendation was developed based on the following study:
https://www.ncbi.nlm.nih.gov/pubmed/30238243Download PDF
0 - 30
This recommendation was developed based on expert opinion, consensus and unpublished institutional data.Download PDF
Obstetrics and Gynecology
Oxycodone 5mg tablets*
0 - 20
This recommendation was based on a study conducted at six academic
medical centers from 9/2014 to 3/2016 involving 720 women
undergoing cesarean delivery in the US.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600205/Download PDF
0 - 20
0 - 15
Orthopaedic Surgery
Oxycodone 5mg tablets*
0 - 30
The manuscript containing this data is currently under review for publication. Michigan OPEN will make the data public upon completion of the review and publication process.Download PDF
0 - 50
The manuscript containing this data is currently under review for publication. Michigan OPEN will make the data public upon completion of the review and publication process.Download PDF
Thoracic Surgery
Oxycodone 5mg tablets*
0 - 25
This recommendation was developed based on data collected from 10 hospitals in
Michigan.Download PDF
Urology
Oxycodone 5mg tablets*
0 - 10
This recommendation was developed based on expert opinion and consensus.
Prospective data collection is ongoing for future revisions.Download PDF
Vascular Surgery
Oxycodone 5mg tablets*
0 - 10
Pediatric Surgery (Patients under 18 years of age)
Opioid Doses
Adenoidectomy
0
Appendectomy
0
Dental Extraction
0
Inguinal Hernia
0
Umbilical Hernia
0
Circumcision
0

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Prescribing Recommendations

Pediatric Prescribing Recommendations

Excessive prescribing of opioids after surgery places patients at risk of becoming new persistent users, a significant surgical complication.

Among opioid-naïve patients undergoing common surgical procedures, 6-10% continue filling opioid prescriptions 3-6 months after surgery.1,2 72% of opioids prescribed by surgeons go unused by patients.3

These procedure-specific prescribing recommendations were developed by Michigan OPEN to curb this over-prescribing of post-operative opioids. These recommendations, for patients with no preoperative opioid use, were informed by patient-reported data from our Collaborative Quality Initiative (CQI) partners, published studies, and expert opinion. For patients taking opioids preoperatively, prescribers are encouraged to use their best judgment.

As part of post-operative pain care, Michigan OPEN strongly advocates patient counseling prior to surgery, and the use of over-the-counter medications, when indicated.

These recommendations will be revised as new data becomes available. Subscribe to be notified by email when the recommendations are updated.

  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.