Post-surgery pain relief has shifted away from medications containing opioids over the past seven years, but the downward trend has slowed since 2020, a new study shows.
Overall, the rate of surgery-related opioid prescriptions dropped by 36% from 2016 to the end of 2022, and the average amount of opioids in those prescriptions dropped by 46%, the study of pharmacy data finds.
That combination of declines means that the total amount of opioids dispensed to surgical patients in late 2022 was 66% lower compared with early 2016, according to the findings published in JAMA Network Open.
But the rate of decline was much faster before the pandemic, the researchers report after comparing surgical opioid patterns before and after 2020.
That’s even after they took into account the unusual circumstances of spring 2020, when most elective surgery temporarily stopped to free up hospital capacity for COVID-19 patients and reduce unnecessary exposure to the SARS-CoV-2 virus.
Even with the overall declines, American surgery patients in late 2022 still received the equivalent of 44 5-milligram pills of hydrocodone from pharmacies after their operations on average. That’s far higher than what patients need for most procedures.
“These data suggest surgical teams have substantially reduced opioid prescribing, but also suggest that efforts to right-size opioid prescriptions after surgery must continue,” says senior author Kao-Ping Chua, an assistant professor of pediatrics at the University of Michigan.
The researchers also find that some types of surgeons have reduced the amount of opioids dispensed to patients more than others. For instance, reductions were particularly large in cardiothoracic surgery and ophthalmology.
Orthopedic surgeons still account for more than half of all surgical opioids dispensed to American patients, even as the rate and size of prescriptions filled by their patients dropped.
Surgeons should not strive to eliminate opioid prescribing altogether, the researchers say.
“The goal should be to ensure that opioids are only prescribed when necessary, and that the amount of opioids prescribed matches the amount that patients need,” says first author Jason Zhang, a former research assistant at the University of Michigan and now in medical school at Northwestern University.
“Achieving these goals could help reduce the risk of opioid misuse, persistent opioid use, and diversion of pills to other people besides the patient.”
The potential for accidental exposure to opioids by others in the household, and interactions between opioids and other substances including alcohol and prescription drugs, are other reasons to focus on non-opioid surgical pain care.
The researchers have studied procedure-related opioid prescribing multiple times, including a recent study showing that the reduction in the rate of dental opioid prescribing has similarly slowed in recent years. They have worked with the Michigan Opioid Prescribing Engagement Network to develop prescribing guidelines for adult and pediatric surgical care.
Surgical organizations and the Centers for Disease Control and Prevention have advised surgeons to rely less on opioid-based acute pain relief for their patients since the mid-2010s. But no studies have examined surgical opioid prescribing trends using pandemic-era data.
The study is based on data from a company called IQVIA that tracks prescriptions dispensed at 92% of United States pharmacies.
The Susan B. Meister Child Health Evaluation and Research Center in the Department of Pediatrics, which also provided some of the funding for the study.
The National Institute on Drug Abuse of the National Institutes of Health, the Benter Foundation, the Michigan Department of Health and Human Services, and the Susan B. Meister Child Health Evaluation and Research Center funded the work.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Source: University of Michigan
