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Michigan OPEN
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OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.

Opioid Prescribing General Publications

Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018

Chua KP; Hu HM; Waljee JF; Brummett CM; Nalliah RP. Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018. JADA. Published online 23 February 2021. DOI: https://doi.org/10.1016/j.adaj.2021.01.001
  • Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of total prescriptions; 
  • Tooth extraction accounted for ⅘ of prescriptions for adolescents and young adults and ⅗ of prescriptions for adults aged 26 through 64 years. 
  • In 2018, 45.3% of tooth extractions resulted in 1 or more initial prescriptions

Association of Postoperative Opioid Prescription Size and Patient Satisfaction

Fry BT; Howard RA; Gunaseelan V; Lee JS; Waljee JF; Englesbe MJ; Vu JV. Association of Postoperative Opioid Prescription Size and Patient Satisfaction. Annals of Surgery. Published online 1 February 2021. DOI: 10.1097/SLA.0000000000004784
  • No significant association between opioid prescription size and satisfaction 
  • 83% of patients receiving the smallest opioid prescription (25 mg OME) were satisfied compared to 85% of patients receiving the largest opioid prescription size (750 mg OME) 

Eliminating Unnecessary Opioid Exposure After Common Children’s Surgeries

Harbaugh CM, Vargas G, Streur CS, et al. Eliminating Unnecessary Opioid Exposure After Common Children's Surgeries. JAMA Surg. 2019;154(12):1154-1155. doi:10.1001/jamasurg.2019.2529
  • A discharge opioid was prescribed to 22% of 675 children younger than 18 years 
    • Median 10 doses (25th to 75th percentile, 6-15) 
  • Circumcision, elbow fracture, and orchiopexy had the highest opioid use; yet only 1 in 3 patients used an opioid, typically for 3 days or less.
  • Overall, pain control was reported as good among 82% of children with or without a discharge opioid prescription.

Association of Opioid Prescribing with Opioid Consumption After Surgery in Michigan

Howard R, Fry B, Gunaseelan V, et al. Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan. JAMA Surg. 2019;154(1):e184234. doi:10.1001/jamasurg.2018.4234
  • Patients use only 27% of opioids prescribed to them 
  • Patients use an additional 5 pills for every 10 extra pills prescribed to them 
  • The quantity of opioid prescribed is associated with higher patient-reported opioid consumption
  • Greater association between prescription size and consumption than reported pain levels and consumption

Patterns of Initial Opioid Prescribing to Opioid-Naive Patients

Larach DB, Waljee JF, Hu HM, et al. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2020;271(2):290-295. doi:10.1097/SLA.0000000000002969
  • The proportion of initial prescriptions for surgery, emergency, and dental care increased by nearly 16% from 2010 to 2016.
  • Dental care prescribing saw the greatest growth, with a 68% increase, while surgical patients received the highest proportion of potent opioids (90.2%).

Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines

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. doi:10.1001/jamasurg.2017.4436
  • Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
  • Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
  • Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.