Post-operative prescription-fill patterns differ amongst patients on high dose opioids

The opioid epidemic has spurred a reconsideration of opioid prescription patterns, especially following surgery.

A team at University of Michigan Medical School, led by Mark Bicket, M.D., Ph.D. of the Department of Anesthesiology, notes a lack of evidence around prescription practices for patients who come to surgery on high doses of opioids for chronic conditions.

This isn't a small gap given that 1 in 5 patients routinely use opioids or are on long term opioid therapy.

To examine how previous opioid use affects post-surgical opioid use, the U-M team investigated a cohort of 72,616 surgical patients.

Of those, 7.4% were on high-dose opioids, 19.5% were on low dose opioids and 73.1percent were not taking opioids prior to surgery.

Interestingly, their analysis found that the number of opioid pills consumed for surgery was similar across all three groups in the first week following discharge.

However, after 90 days, patients who were already on high dose opioids were much more likely to obtain prescription refills on par with the amount of opioids they were taking before surgery.

The results, the authors note, highlight the need for perioperative strategies that account for preoperative opioid use and for structured transitions back to patients’ usual prescribers to support safe, effective opioid stewardship.

Additional authors: Michael F McGee, Vidhya Gunaseelan, Michael J Englesbe, Pooja Lagisetty, Chad M Brummett, Amy Bohnert, Yi Li, Jennifer F Waljee

Paper cited: “Opioid Consumption and Fills After Surgery Among Adults on High-Dose Prescription Opioids,” Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001919

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