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Michigan OPEN

Publications

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.

Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults

Harbaugh CM, Lee JS, Chua KP, et al. Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults. JAMA Surg. 2019;154(4):e185838. doi:10.1001/jamasurg.2018.5838
  • Persistent opioid use occurred in 4.1% of patients with long-term opioid use in a family member compared with 2.4% of patients without long-term opioid use in a family member.
  • Long-term opioid use among family members is associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgical and dental procedures.

Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery

Howard RA, Ryan A, Hu HM, Craig SB, Waljee JF, Bicket MC, Englesbe MJ, Brummett CM. Ann Surg: 2 January, 2023. DOI: 10.1097/SLA.0000000000005792
  • In Michigan, new persistent opioid use rate decreased from 3.29% to 2.51% following the release of prescribing guidelines, which was an additional 0.53% decrease compared to patients outside of Michigan.   
  • Mean opioid prescription quantity for patients in Michigan decreased from 199.5 oral morphine equivalents (OMEs) to 88.6 OMEs after prescribing guidelines were released, which was an additional 55.7 OMEs decrease compared to patients outside of Michigan.

Assessment of a Quality Improvement Intervention to Decrease Opioid Prescribing in a Regional Health System

Brown CS, Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system. BMJ Quality & Safety. Published Online First: 16 September 2020. doi: 10.1136/bmjqs-2020-011295
  • The use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing and consumption by 50%.
  • Saw zero change in patient reported satisfaction and pain scores

Statewide Implementation of Postoperative Opioid Prescribing Guidelines

Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Statewide Implementation of Postoperative Opioid Prescribing Guidelines. N Engl J Med. 2019;381(7):680-682. doi:10.1056/NEJMc1905045
  • Mean prescription size decreased by 8 pills after the guidelines were released and opioid consumption decreased by 3 pills
  • Reduced prescription size and opioid use had no impact on patient satisfaction or pain scores

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) 
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