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

Less is More: Fulfillment of Opioid Prescriptions Before and After Implementation of a Modifier 22 Based Quality Incentive for Opioid-Free Vasectomies

Nam, C. S., Lai, Y. L., Hu, H. M., George, A. K., Linsell, S., Ferrante, S., Brummett, C. M., Waljee, J. F., & Dupree, J. M. (2022). Less is More: Fulfillment of Opioid Prescriptions Before and After Implementation of a Modifier 22 Based Quality Incentive for Opioid-Free Vasectomies. Urology, S0090-4295(22)00868-8. Advance online publication. https://doi.org/10.1016/j.urology.2022.09.023
  • Prior to implementation of the modifier 22 opioid sparing vasectomy incentive, 32.5% of men filled an opioid prescription following a vasectomy. After implementation, only 12.6% of men filled an opioid prescription, which is a 19.9% absolute decrease and 61% relative decrease. 
  • Estimated the equivalent of 8,743 fewer oxycodone 5mg pills were dispensed in Michigan from July 7, 2019 to November 16, 2020

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 days or less were associated with a reduction in opioid prescribing by 1.7 days per enrollee.

Association of State Opioid Duration Limits with Postoperative Opioid Prescribing

Agarwal S, Bryan JD, Hu HM, et al. Association of State Opioid Duration Limits With Postoperative Opioid Prescribing. JAMA Netw Open. 2019;2(12):e1918361. Published 2019 Dec 2. doi:10.1001/jamanetworkopen.2019.18361
  • In Massachusetts, the implementation of 7-day limits on initial opioid prescriptions for acute pain was associated with a decrease in prescription size of 38 OMEs and additional reduction of 1.5 OMEs per month.  
  • The implementation was also associated with an average decrease of 0.4 days supplied and the proportion of prescriptions exceeding a 7-day supply (−5.9 percentage points).
  • Limit implementation in Connecticut was not associated with changes in prescription sizes suggesting that opioid duration limits have variable association with postoperative opioid prescribing.

Association of Hydrocodone Schedule Change with Opioid Prescriptions Following Surgery

Habbouche J, Lee J, Steiger R, et al. Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery [published correction appears in JAMA Surg. 2018 Dec 1;153(12):1164]. JAMA Surg. 2018;153(12):1111-1119. doi:10.1001/jamasurg.2018.2651
  • After hydrocodone was changed from a schedule III to schedule II-controlled substance, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs, equivalent to 7 tablets of hydrocodone. 
  • Following the schedule change, an increase in OMEs was observed among patients undergoing general surgery (mean difference of 28 OME), cardiac surgery (123.3 OME), orthopedic surgery (20.5 OME), spine surgery (66 OME), and vascular surgery (47 OME). 
  • After scheduling change there was an increase in initial postoperative opioid amounts among opioid-naive patients (mean difference of 16.8 OMEs) and intermittent opioid users (60.3 OME), but not among long term opioid users.