Patterns in Opioid Prescription for Patients Operatively Treated for Ankle Fractures Following Implementation of 2017 Ohio Opioid Prescriber Law

Abstract

Background: The purpose of this study was to report patterns of opioid prescription for patients treated operatively for ankle fractures after implementation of the 2017 Ohio Opioid Prescriber Law in comparison to the previous year. Methods: A total of 144 patients operatively treated for isolated ankle fractures during two 6-month periods, January 2017 to July 2017 (pre-law) and January 2018 to July 2018 (post-law), were retrospectively identified. Preoperative and postoperative patient narcotic use was reviewed using a legal prescriber database. Total number of prescriptions, quantity of pills, and morphine milligram equivalents (MMEs) per patient prescribed during the 90-day postoperative period were compared between those treated before and those treated after implementation of the Ohio prescriber law. Results: The average number of opioid prescriptions prescribed per patient in the 90-day postoperative period was 2.3 in the pre-law group and 2.1 in the post-law group ( P = .625). The average MMEs prescribed per patient dropped from 942.4 MME pre-law to 700.5 MME post-law ( P = .295). Differences in the average number of pills per prescription pre- and post-law (49.7 vs 36.2) and average MME per prescription (382.1 mg vs 275.2 mg) were statistically significant ( P < .001 and P = .016, respectively). Conclusion: Following the implementation of the 2017 Ohio Opioid Prescriber Law, there was a downward trend in the number of pills per prescription and MMEs per prescription in patients operatively treated for isolated ankle fractures. The presence of a downward trend in the quantity of opioids prescribed in this patient cohort suggests the effectiveness of the state law. Level of Evidence: Level III, comparative study.

Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership

“…To better illustrate this distribution in context with two of the most prescribed opioids after ankle and distal radius ORIF (Percocet, oxycodone 5 mg and Dilaudid, hydromorphone 1 mg), this would represent a range of 75-300 and 40-160 morphine milligram equivalent (MME), respectively. Te quantity of opioids prescribed in the frst prescription is similar to the American literature-reported values for both distal radius and ankle ORIF and lower than that of elective orthopaedic procedures [18,19]. Respondents in our survey also prescribed both "strong" opioids such as hydromorphone and oxycodone (contained in Percocet), as well as codeine (contained in Tylenol #3) and tramadol (contained in Tramacet), sometimes referred to as "weak" opioids.…”

Patients With Opioid Use Disorder Have Increased Readmission Rates, Emergency Room Visits, and Costs Following a Hallux Valgus Procedure

“…[4][5][6][7][8][9] Moreover, patients who have been treated with more restrictive opioid regimes have been observed to require fewer prescription refills and fewer postoperative appointments following foot and ankle surgery. 10 Despite this evidence, the number of chronic pain patients treated with postoperative opioids continues to increase. 11 Although several studies have elaborated preoperative opioid use among foot and ankle patients, to our knowledge, the literature is scarce regarding those diagnosed with opioid use disorder (OUD) before surgery.…”