OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
- Initial opioid prescriptions after dental procedures were associated with a higher risk of opioid overdose in patients.
- The magnitude of increased risk was greater in patients who were publicly insured and in patients who had mental health or substance use disorders. Among privately insured patients in family plans, initial opioid prescriptions after dental procedures were associated with a higher risk of overdose in patients’ family members.
- These findings highlight the importance of avoiding unnecessary dental opioid prescribing.
- Exposure to opioids in the perioperative period is associated with new persistent use in patients who were previously opioid-naïve. New persistent opioid use was higher in patients having an initial perioperative opioid fill (3.4%) than patients without an initial perioperative fill (0.6%).
- After adjusting for patient characteristics, initial perioperative opioid fill was independently associated with an increased odds of new persistent use.
- Surgeons should be aware of those risks to identify at-risk patients in the current national opioid crisis and minimize prescribing opioids when possible.
Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018Chua KP; Hu HM; Waljee JF; Nalliah RP; Brummett CM; Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018. JAMA Network Open. Published online 16 April 2021. DOI: 10.1001/jamanetworkopen.2021.6464
- Persistent opioid use was defined as 1 or more dispensed opioid prescriptions 4 to 90 days after the index date and 1 or more prescriptions 91 to 365 days after the index date. Overall POU was 1.3%, and the risk of POU was higher among publicly insured (2.0%) than privately insured patients (0.9%).
- The initial dental opioid prescriptions were associated with a 1.0–percentage point higher risk of POU among publicly insured patients compared with privately insured patients.
- The results further highlight the importance of avoiding dental opioid prescribing when nonopioids provide effective analgesia, which is the case for most dental procedures.
Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patientsHur J; Tang S; Gunaseelan V; Vu J; Brummett CM; Englesbe MJ; Waljee JF; Wiens J. Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patients. American Journal of Surgery. Published online 26 March 2021. DOI: https://doi.org/10.1016/j.amjsurg.2021.03.058
- Potential predictors included sociodemographic data, comorbidities, and prescriptions within one year prior to surgery.
- Undergoing major surgery, opioid prescriptions within 30 days prior to surgery, and abdominal pain were useful in predicting refills; back/joint/head pain were the most important features in predicting new persistent use.
- Preoperative patient attributes from insurance claims could potentially be useful in guiding prescription practices for opioid-naïve patients.
Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018Chua 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.
- Opioid prescribing for tooth extractions is declining but remains common, despite the availability of equally effective nonopioid alternatives.
- Eliminating routine opioid prescribing for tooth extraction could reduce dental opioid exposure substantially.
- In a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction.
- This suggests surgeons may continue to decrease postoperative opioid prescription sizes in order to mitigate opioid-related risks without compromising patient satisfaction.
- Patients prescribed hydrocodone consumed 7 tablets (95% CI 6.79-7.18) while patients prescribed oxycodone consumed 6 tablets (95% CI 5.58-6.40.)
- Although patients prescribed hydrocodone consumed more tablets than patients prescribed oxycodone, this difference was not clinically significant and did not result in differences in satisfaction, pain, or refills.
- Perioperative opioid prescribing guidelines may recommend the same number of 5 mg oxycodone and hydrocodone tablets without sacrificing patient-reported outcomes.
- Patients participating in an opioid-sparing postoperative pathway received and used fewer opioids but reported less pain and similar satisfaction compared with patients receiving standard of care.
- In the opioid-sparing pathway, 36.8% of patients did not receive an opioid prescription compared with 0% of patients receiving standard of care.
- Importantly, more patients in the opioid-sparing group received no opioid prescription, which avoids the risk of diversion into communities.
- About 26.3% of opioid-naïve patients obtained refills of their opioid prescriptions within 30 days of surgery.
- The likelihood of obtaining a refill was unchanged with the size of the initial perioperative prescription across procedure categories.
- Patient factors associated with increased likelihood of refills included age 30 to 39 years, female gender, anxiety disorder, mood disorder, and history of alcohol/substance abuse.
- For opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.
- Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant.
- Among previously opioid-naïve patients, 4% developed chronic use posttransplant.
- Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant.
- To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.