OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
Piloting a statewide emergency department take-home naloxone program: Improving the quality of care for patients at risk of opioid overdoseDora-Laskey, A., Kellenberg, J., Dahlem, C.H., English, E., Walker, M. G., Brummett, C.M., Kocher, K.E. Published online 28 December, 2021 https://doi.org/10.1111/acem.14435
- More than 140 providers were trained in the use of medications for OUD in acute care settings.
- A total of 872 naloxone rescue kits were distributed to ED patients at risk of opioid overdose during the first phase of this project.
- A statewide ED take-home naloxone program was shown to be feasible across a range of different hospitals with varying maturity in preexisting OUD resources and capabilities.
- Opioid-related morbidity and mortality have dramatically increased in the United States over the last several decades.
- Opioid prescribing after surgery has often been in excess, in part owing to the absence of clear prescribing guidelines based on patient-reported pain and opioid-related outcomes.
- Disposal of excess pills after surgery remains low, and unused opioid pills are an important contributor to the opioid epidemic owing to diversion and misuse.
High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young AdultsVargas GM; Gunaseelan V; Upp L; Deans KJ; Minneci PC; Gadepalli SK; Englesbe MJ; Waljee JF; Harbaugh CM. High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults. Annals of Surgery. Published online 27 August 2021. DOI: 10.1097/SLA.0000000000005193
- High-risk opioid prescribing practices increased from 34.9% to 43.5% in opioid-naïve patients aged 13-21 from 2008 to 2016; the largest increase was in co-prescribed benzodiazepines (24.1% to 33.4%).
- High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients’ risk of persistent opioid use.
- Most opioid prescriptions to patients with persistent use beyond the postoperative period were from non-surgical prescribers (79.6%).
- Among patients not using opioids preoperatively, a history of opioid use was independently associated with new persistent opioid use after surgery, especially those with a history of continuous opioid use.
- Similarly, history of opioid use was independently associated with opioid prescription refill at 1 month after surgery.
- Moderate to high alcohol use was associated with new persistent use as well as opioid prescription refill at 1 month
Association of State Opioid Prescription Duration Limits With Changes in Opioid Prescribing for Medicare BeneficiariesCramer 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 day or less were associated with a reduction in opioid prescribing by 1.7 days per enrollee.
- The state legislation on opioid prescribing primarily targets initial opioid prescriptions provided for acute pain, and we observed decreases that were most pronounced among surgeons and dentists.
- Among patients admitted for traumatic injury, 8.6% developed new persistent opioid use.
- Patients suffering from extremity and abdominal injuries are at highest risk.
- Maximum individual region injury severity predicts development of new persistent use, whereas total injury severity does not.
Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgeryBrown CS; Osborne NH; Hu HM; Coleman D; Englesbe MJ; Waljee JF; Brummett CM; Vemuri C. Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgery. Vascular. Published online 15 June 2021. DOI: 10.1177/17085381211024514
- Among opioid-naïve patients undergoing vascular surgery procedures in Medicare between 2009 and 2017, 2.6% of all patients developed new persistent use.
- Undergoing endovascular carotid or venous surgery was associated with an increased risk of NPOU, whereas no differences were found between endovascular and open approaches for peripheral arterial or aortic disease.
- Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids.
- This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.
- The predicted probability of being highly satisfied after surgery was 79% for patients who had no complications and 88% for patients who had no pain.
- Patients who experienced postoperative complications and pain were less likely to be highly satisfied or have no regret.
- Notably, postoperative pain has a more significant effect on satisfaction and regret after surgery, suggesting focused postsurgical pain management is an opportunity to substantially improve patient experiences.
A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-AgencyCho HE, Billig JI, Byrnes ME, Nasser JS, Kocheril AP, Haase SC, Waljee JF, Chung KC. A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency. Plastic and Reconstructive Surgery. Published online 1 May 2021. DOI: 10.1097/PRS.0000000000007841
- Participants actively sought out protective mechanisms supporting their decision on opioid use, but sometimes did so unconsciously. Participants integrated a strong sense of self in their decision-making processes.
- A robust understanding of how patients choose to take opioids for postoperative pain control is imperative to develop patient-centered strategies to treat the opioid epidemic.
- Effective opioid-reduction policies should consider patients as active agents who negotiate various internal and external influences in their decision-making processes.