Publications

• 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.

• 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

• 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

• 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

• 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) 

• 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.

• 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

• 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%).

• 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.

• 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