Publications (Old)
OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
Preoperative Opioid Use and Readmissions Following Surgery
Tang R, Santosa KB, Vu JV, et al. Preoperative Opioid Use and Readmissions Following Surgery [published online ahead of print, 2020 Mar 13]. Ann Surg. 2020;10.1097/SLA.0000000000003827. doi:10.1097/SLA.0000000000003827- Among the Medicare patient population who undergo elective surgery, 55% were opioid naïve while the remaining 45% filled one or more opioid prescriptions in the 12 months before surgery.
- Higher levels of preoperative opioid exposure were associated with higher rates of opioid-related readmissions, pain-related readmissions, respiratory-related readmissions, and all-cause readmissions.
Substance Use Disorder General Publications
Classifying Preoperative Opioid Use for Surgical Care
Vu JV, Cron DC, Lee JS, et al. Classifying Preoperative Opioid Use for Surgical Care. Ann Surg. 2020;271(6):1080-1086. doi:10.1097/SLA.0000000000003109- Preoperative opioid use is common among patients who undergo elective surgery, with 38% filling an opioid prescription in the 12 months before surgery.
- Even minimal opioid use before surgery increases the probability of needing additional postoperative prescriptions in the 30 days after surgery.
Care Coordination for Patients on Chronic Opioid Therapy Following Surgery
Lagisetty P, Bohnert A, Goesling J, et al. Care Coordination for Patients on Chronic Opioid Therapy Following Surgery: A Cohort Study. Ann Surg. 2020;272(2):304-310. doi:10.1097/SLA.0000000000003235- 10% of patients did not have a usual prescriber preoperatively and were more likely to have prescriptions from multiple prescribers and new long-acting opioid prescriptions.
- 73.8% of patients were exposed to high risk prescribing postoperatively.
Piloting a statewide emergency department take-home naloxone program: Improving the quality of care for patients at risk of opioid overdose
Dora-Laskey A, Kellenberg J, Dahlem CH, English E, Gonzalez Walker M, Brummett CM, Kocher KE. Piloting a statewide emergency department take-home naloxone program: Improving the quality of care for patients at risk of opioid overdose. Acad Emerg Med. 2022 Apr;29(4):442-455. doi: 10.1111/acem.14435. Epub 2022 Jan 28. PMID: 34962682.- Total of 2400 naloxone kits were assembled and shipped to 9 hospitals in Michigan. By February 2021, 872 kits were distributed to ED patients
- Sites dispensed an average of 1.05 kits per month per 1000 ED visits
- 140 providers were trained in use of medications for OUD acute care settings
Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults
Lin LA, Brummett CM, Waljee JF, Englesbe MJ, Gunaseelan V, Bohnert ASB. Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults. J Gen Intern Med. 2020;35(2):420-427. doi:10.1007/s11606-019-05423-7- Among those who filled naloxone, 94% were patients who had received an opioid during the study period
- < 2% of patients in overdose risk factor groups filled naloxone
- Despite increases in naloxone prescribing, the prevalence of naloxone fills by patients at high risk of overdose remains minimal
Opioid Prescribing General Publications
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.