Post-operative opioid prescription and usage patterns: impact of public awareness and state mandated prescription policy implementation
*Mayo H. Fujii1, Ajai K. Malhotra1, *Ethan Jones1, *Thomas P. Ahern2, *Loic Fabricant1, *Christos Colovos1
1University of Vermont Medical Center, Burlington, VT;2University of Vermont Larner College of Medicine, Burlington, VT
Objective: To compare post-discharge opioid prescribing, use and patient satisfaction before and after implementation of a state-mandated policy on opioid prescribing.
Design: Patient telephone questionnaire data obtained 1-2 weeks post-discharge. Electronic medical record data obtained 30 days post-discharge.
Setting: 562-bed tertiary-care academic medical center.
Patients: A consecutive sample of patients undergoing 15 common surgical procedures across four specialties within our 3-year prospective database (PRE: July 2016-June 2017, n=365; POST: September 2017-February 2019, n=768).
Interventions: State-mandated policy change on opioid prescribing implemented in July 2017.
Main Outcome Measures: Amount of opioid medication prescribed and used in morphine milligram equivalents (MME), prescription refill rate, patient-reported adequacy of prescription size.
Results: Statistically significant decrease in median MME prescribed and used across all procedures (p<0.05 for both - see Table). Proportion of patients not prescribed any opioid increased (PRE: 12.7%, POST: 26.0%, p<0.05). There was no statistically significant change in refill rates (PRE: 5.5%, POST 6.3%, p>0.05) nor in the proportion of patients reporting inadequate prescription size (PRE: 11%, POST: 12.3%, p>0.05).
Conclusions: After the implementation of a state-mandated policy change on opioid prescribing, there were statistically significant decreases in the amount of opioid medication prescribed and used, and comparable patient-reported satisfaction with the amount prescribed after common surgical procedures.
| PRE (n=365) | POST (n=768) | |
| MME Prescribed (IQR)* | 96 (50-160) | 64 (0-80) |
| MME Used (IQR)* | 18 (0-80) | 0 (0-40) |
| *p<0.05 |
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