Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation

Abstract

IMPORTANCE Understanding whether statewide legislation, such as the Michigan Opioid Laws, is associated with reduction in postoperative opioid prescriptions is informative in guiding future legislation.OBJECTIVE To identify changes in opioid prescribing patterns for oculoplastic and orbital procedures associated with the enactment of the Michigan Opioid Laws in 2017 and 2018. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study included 3781 patients who underwent any of 10 common oculoplastic and orbital procedures between June 1, 2016, and November 30, 2019, at a tertiary care institution.EXPOSURES From 2017 to 2018, Michigan enacted a series of laws to address the state's worsening opioid epidemic. Two major components of this legislation enacted on June 1, 2018, required prescribers to review a report of patients' opioid use history and obtain signed consent after educating patients on the use and disposal of opioids prior to prescribing.MAIN OUTCOMES AND MEASURES Demographic information, type of surgery, type and amount of opioid prescriptions, and morphine milligram equivalent (MME) were analyzed. MME was calculated as the product of dose, quantity, and opioid-specific conversion factor for each prescription. Linear interpolation spline regression was used to evaluate the association of prescription MME with time. RESULTSOf 3781 patients, 1614 (42.7%) were male. The mean (SD) age at the time of surgery was 63.3 (16.6) years. Of 2026 patients undergoing surgery before June 1, 2018, 1782 (88.0%) were prescribed postoperative opioids; of 1755 patients undergoing surgery after June 1, 2018, 878 (50.0%) were prescribed postoperative opioids (P < .001). There was no difference in age, sex, race/ethnicity, surgery type, or opioids prescribed between these 2 cohorts. Linear interpolation spline regression showed a decrease of 26.025 MMEs (equivalent to a 36.2% reduction of mean MME) between June 1, 2017, and September 30, 2018 (β, −1.735; 95% CI, −0.088 to −0.024; P < .001), stabilizing at a persistently reduced rate of MME prescribed through the end of the study period (October 1, 2018, to November 30, 2019; β, −0.005; 95% CI, −0.039 to 0.016; P = .42). Changes in MME in the 12 months before or 12 months after the period of legislation enactment were not identified. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, reduction in opioid prescriptions for oculoplastic and orbital procedures was observed during the enactment period of the Michigan Opioid Laws and appeared to be sustained through the end of the study period. Similar statewide or national legislations aimed at increasing prescriber awareness and patient education on opioid use may help curtail the prescription opioid epidemic.

Opioid Prescribing Patterns of Optometrists in the Medicare Part D Database

“…Going forward, further investigation into opioid prescribing to the non-Medicare population, the unsuppressed total number of opioid prescriptions written, duration of prescriptions, and morphine milliequivalents per prescription is needed to better understand opioid prescribing practices of optometrists as a medical specialty. Analysis of co-managed surgical patients of recently published opioid prescribing ophthalmic subspecialties such as ophthalmic plastic surgery, ocular oncology, and cornea would also be beneficial to help better understand co-managed patients' pain needs 10–12 . Additional analysis by practice setting (combined OD/MD practices, hospital-based practices, skilled nursing, and rehabilitation facilities) and comparison of opioid prescribing patterns of optometrists with ophthalmologists would be beneficial to understand opioid prescribing practices of optometrists for other special patient populations.…”

“…To date, there has been no investigation into the pattern of opioid prescribing by optometrists. Previous studies examining the opioid prescribing rates of eye care providers have focused on the amount of general opioid prescriptions written by ophthalmologists 8–15 . The role of the optometrist prescribing opioids is relevant not only for analysis of clinical practice patterns for primary eye care, but with the trend of co-managed surgical patients, optometrists are often co-managing post-operative surgical patients 24 to 36 hours after surgery 16 .…”

“…Previous studies examining the opioid prescribing rates of eye care providers have focused on the amount of general opioid prescriptions written by ophthalmologists. [8][9][10][11][12][13][14][15] The role of the optometrist prescribing opioids is relevant not only for analysis of clinical practice patterns for primary eye care, but with the trend of co-managed surgical patients, optometrists are often co-managing post-operative surgical patients 24 to 36 hours after surgery. 16 The purpose of this study is to examine the prescription rates and prescribing trends of opioids by optometrists listed in the Centers for Medicare & Medicaid Services (CMS) part D database.…”

Opioid Prescribing Patterns for Ulcerative Keratitis

“…54 The median 100 MME (mean = 203 MME) prescribed to patients with keratitis within 90 days of diagnosis in this study is surprisingly higher than the average 80 MME that is prescribed within 90 days postoperatively for orbital and oculoplastic surgery. 52 A query of a large national US insurer's claims database found that 1.9% of incisional ocular surgeries were associated with an opioid prescription. In this same study, the opioid prescription rate was 6.1% for corneal surgeries alone.…”

“…In ophthalmology, prescribing patterns have been analyzed largely in the context of perioperative pain management and at a global specialty level. 28,29,[51][52][53][54] Based on analysis of Medicare Part D Prescription Drug Program data from 2013 to 2015, Patel and Sternberg found that almost 90% of ophthalmologists wrote 10 or fewer opioid prescriptions annually, with a mean supply of 5 days. 54 The median 100 MME (mean = 203 MME) prescribed to patients with keratitis within 90 days of diagnosis in this study is surprisingly higher than the average 80 MME that is prescribed within 90 days postoperatively for orbital and oculoplastic surgery.…”