Opioid prescriptions for acute pain after outpatient surgery at a large public university-affiliated hospital: Impact of state legislation in Florida

Potnuru, Paul; Dudaryk, Roman; Gebhard, Ralf E.; Diez, Christian; Velázquez, Omaida C.; Candiotti, Keith A.; Epstein, Richard H.

doi:10.1016/j.surg.2019.04.022

Cited by 34 publications

(32 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…22 Another single-institution study in Florida observed a decrease by more than 30% in opioid prescriptions for patients undergoing common outpatient surgical procedures after prescribing limit implementation. 23 It should be noted that Rhode Island's limit is much more restrictive in that it limits opioid prescriptions to 20 doses, while Florida's limit restricts prescriptions to a 3-day supply. Even if some variation on limits may be able to achieve greater prescribing reductions, it is important to consider that the goal is not absolute reduction alone, but rather reductions of prescribing that exceed clinical need.…”

Section: Discussionmentioning

confidence: 99%

Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

Agarwal

Bryan

et al. 2019

JAMA Netw Open

View full text Add to dashboard Cite

IMPORTANCE Since the Centers for Disease Control and Prevention published opioid prescribing guidelines in March 2016, 31 states have implemented legislation to restrict the duration of opioid prescriptions for acute pain. However, the association of these policies with the amount of opioid prescribed following surgery remains unknown. OBJECTIVE To examine the association of opioid prescribing duration limits with postoperative opioid prescribing in Massachusetts and Connecticut, the first 2 states to implement limits after March 2016. DESIGN, SETTING, AND PARTICIPANTS This interrupted time series analysis and cross-sectional study examined immediate level and slope changes in monthly outcomes after prescribing limit implementation in Massachusetts and Connecticut. These states implemented 7-day limits on initial

show abstract

Section: Discussionmentioning

confidence: 99%

Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

Agarwal

Bryan

et al. 2019

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…This conflict in results may be explained by differences in methodology. In Potnuru's study, pre-intervention indicators of opioid use were compared with post-intervention indicators but there was no accounting for pre-intervention trends, which means the effect reported may have been similar to the downward trend we see in our own data rather than directly attributable to the legislative action [38]. A similar methodology was employed in Reid's [37] study, leading to similar lack of accounting for pre-intervention trends.…”

Section: Discussionmentioning

confidence: 85%

“…Agarwal and colleagues [33] found variable association of state-level opioid prescribing limits with post-operative opioid prescribing in Massachusetts and Connecticut, but even when a decrease was observed, the magnitude was small. In contrast, study of similar legislation in Rhode Island and Florida demonstrated significant decreases in post-surgical opioid prescribing specifically after state-level opioid prescription limits [36][37][38].…”

Section: Discussionmentioning

confidence: 85%

Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia

Sedney

Khodaverdi

Pollini

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods: Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “day’s supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control.Results: Our analysis demonstrates a statistically significant decrease in overall state opioid prescribing as well as average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions.Conclusion: Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small overall decrease of average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

show abstract

“…Our colleagues found 90% compliance with the 3-day supply after the law; in the present study, there was an initially lower compliance rate of 74%, though this increased to 97% at 1 year. 21 This suggests that the law required some time for providers in our department to adjust their prescribing habits, but this was largely achieved by 1 year.…”

Section: Discussionmentioning

confidence: 99%

Changes in Single‐Specialty Postoperative Opioid Prescribing Patterns in Response to Legislation: Single‐Institution Analysis Over Time

Katz

Misztal

Ghiam

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objectives To determine changes in the prescriptions of postoperative opioids in response to Florida state legislation restricting the number of days for which these medications could be prescribed to 3 days in most circumstances or 7 days at provider discretion. Study Design A retrospective review was performed for all patients undergoing 7 common outpatient otolaryngology surgical procedures. Setting Single-institution academic center in Florida. Methods Query of the state’s online prescription drug monitoring program was used to compare prescription habits 3 months before and after the law and then again 1 year later. Results A total of 561 patients were identified meeting criteria. The number of days that opioids were prescribed decreased significantly, from 6.42 to 4.48 to 3.03 days. There was a significant decrease in the proportion of patients receiving any postoperative opioid prescription, from 0.80 to 0.52 to 0.32. The total morphine milligram equivalents prescribed decreased from 28.4 before the law to 18.4 at 1 year after. Conclusions Legislative restrictions on the length of opioid prescriptions were associated with significant decreases in the proportion of patients receiving any opioids, the number of days that opioids were prescribed, and the total morphine milligram equivalents 3 months after the law went into effect, with even more dramatic changes at the 1-year time point. We opine that these changes are due to providers learning that many procedures do not require postoperative opioids and therefore increasingly considering and utilizing nonopioid alternatives in this setting.

show abstract

Opioid prescriptions for acute pain after outpatient surgery at a large public university-affiliated hospital: Impact of state legislation in Florida

Cited by 34 publications

References 17 publications

Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia

Changes in Single‐Specialty Postoperative Opioid Prescribing Patterns in Response to Legislation: Single‐Institution Analysis Over Time

Contact Info

Product

Resources

About