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Michigan OPEN

Publications (Old)

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

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.

Safe Storage and Disposal General Publications

Association of Caregiver-Reported Education With Locked Storage and Disposal of Prescription Opioids After Children’s Surgery

Sloss, K. R., Vargas, G., Brummett, C. M., Englesbe, M. J., Waljee, J. F., Gadepalli, S., & Harbaugh, C. (2020). Association of caregiver-reported education with locked storage and disposal of prescription opioids after children’s surgery. Journal of pediatric surgery, 55(11), 2442–2447. https://doi.org/10.1016/j.jpedsurg.2020.04.022

Assessment of Prescriber and Pharmacy Shopping Among the Family Members of Patients Prescribed Opioids

Chua KP, Brummett CM, Conti RM, Haffajee RL, Prosser LA, Bohnert ASB. Assessment of Prescriber and Pharmacy Shopping Among the Family Members of Patients Prescribed Opioids. JAMA Netw Open. 2019 May 3;2(5):e193673. doi: 10.1001/jamanetworkopen.2019.3673. PMID: 31074819; PMCID: PMC6512276.
  • In 2016, 8485 (0.6%) of the 1.5 million opioid prescriptions filled by US adults and children with family insurance plans occurred when at least 1 family member met criteria for prescriber and pharmacy shopping. *
  • Among the 8485 index fills, 68.1% of prescribing clinicians were physicians, 7.9% were physician assistants, 7.2% were nurse practitioners, and 43% were dentists.
  • The most common physician specialties among the 8485 index fills were family medicine (17.1%), pain medicine (16.4%), internal medicine (9.6%), and orthopedic surgery (6.5%)

*prescriber and pharmacy shopping is when an individual obtains opioids from high numbers of prescribers and pharmacies

 

Association of Caregiver-reported education with locked storage and disposal of Prescription opioids after Children’s surgery

Sloss KR, Vargas G, Brummett CM, et al. Association of caregiver-reported education with locked storage and disposal of prescription opioids after children's surgery. Journal of Pediatric Surgery. 2020 Nov;55(11):2442-2447. DOI: 10.1016/j.jpedsurg.2020.04.022. PMID: 32507640.
  • 60.4% of caregivers reported storage education despite only 18.3% keeping the opioids in locked storage. Caregivers who reported verbal and/or written storage education were more likely to lock opioids in storage
  • Of the 606 caregivers surveyed, 451 (74%) had leftover opioids. Of the 451, only half (50.1%) reported disposal education and a quarter (24.6%) disposed of the excess opioids. 
  • There was no association between leftover opioid disposal and verbal and/or written disposal education.

 

Effect of Drug Disposal Bag Provision on Proper Disposal of Unused Opioids by Families of Pediatric Surgical Patients: A Randomized Clinical Trial

Lawrence AE, Carsel AJ, Leonhart KL, et al. Effect of Drug Disposal Bag Provision on Proper Disposal of Unused Opioids by Families of Pediatric Surgical Patients: A Randomized Clinical Trial. JAMA Pediatrics. 2019 Aug;173(8):e191695. DOI: 10.1001/jamapediatrics.2019.1695. PMID: 31233129; PMCID: PMC6593625
  • 56% of families who only received standard postoperative discharge instructions on opioid safety reported proper opioid disposal compared to 72% of families who received a drug disposal bag and the standard postoperative discharge instructions.
  • 20% increase in the rate of proper opioid disposal with the provision of a drug disposal bag. 
  • Higher than expected rate of opioid disposal among families that did not receive a disposal bag suggests that standardized, multimodal, opioid related education provided to families of surgical patients does impact disposal rates.

 

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