The impact of state-mandated opioid prescribing restrictions on prescribing patterns surrounding reverse total shoulder arthroplasty

Sabesan, Vani J.; Echeverry, BS Nikolas; Dalton, Conner; Grunhut, Joel; Lavin, Alessia; Chatha, Kiran

doi:10.1016/j.jseint.2021.04.009

Cited by 5 publications

(10 citation statements)

References 27 publications

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“…The key characteristics of the 66 included studies [ 5 , 50 – 114 ] are detailed in Table 1 : Study Characteristics, Description of Strategies and Outcomes. Most studies used a retrospective cohort ( n = 35) [ 5 , 52 , 56 , 60 , 72 – 74 , 78 – 89 , 91 – 94 , 97 – 99 , 101 – 105 , 108 , 109 , 111 , 112 ], a randomized controlled trial (RCT) ( n = 24) [ 50 , 51 , 53 – 55 , 57 , 59 , 61 , 62 , 65 – 71 , 75 , 76 , 95 , 100 , 106 , 107 , 113 , 114 ] or a prospective cohort ( n = 7) [ 58 , 63 , 64 , 77 , 90 , 96 , 110 ] design. Almost all the studies were conducted in the U.S. ( n = 58) [ 5 , 50 – 57 , 59 – 61 , 63 , 67 – 74 , 77 – 99 , 101 – 114 ].…”

Section: Resultsmentioning

confidence: 99%

“…As described in Table 1 : Study Characteristics, Description of Strategies and Outcomes, selected studies were divided in seven categories, according to the type of strategy assessed. Among system-based strategies, we identified 22 studies on hospital-based protocols to limit or improve opioid prescriptions ( n = 13) [ 77 – 83 , 89 , 90 , 92 , 96 , 97 , 102 ] or formal government regulation in some U.S. states to limit opioid prescriptions ( n = 9) [ 85 – 88 , 91 , 93 , 103 – 105 ]. Among pharmacological strategies, we identified 18 studies [ 62 – 76 , 94 , 98 , 99 , 106 ], which mainly focused on the effect of anesthetic agents administered through regional anesthesia ( n = 8) [ 62 , 65 , 70 , 73 , 74 , 94 , 98 , 99 ] and the impact of medication on the central nervous system [ 63 , 66 , 67 , 69 ] ( n = 4) and opioid use.…”

Section: Resultsmentioning

confidence: 99%

“…The most commonly measured outcome was the quantity of opioids in morphine equivalent doses (MEDs) ( n = 44) [ 53 , 55 – 59 , 61 , 63 , 68 , 70 , 72 , 74 – 77 , 79 – 87 , 89 – 93 , 96 – 108 , 110 , 111 ], generally measured at 6 weeks or 1, 3 and 6 months. The proportion of patients using opioids was the second most frequently used outcome measure in the selected studies ( n = 25) [ 5 , 53 , 57 , 58 , 62 – 65 , 67 , 69 , 72 , 73 , 78 , 81 , 86 , 94 , 96 , 100 , 101 , 105 , 107 , 109 , 112 , 114 , 134 ] and this evaluation was often conducted at 3 ( n = 13) [ 5 , 53 , 57 , 62 , 63 , 65 , 72 , 81 , 94 , 100 , 105 , 112 , 114 ] and 6 months ( n = 6) [ 64 , 67 , 78 , 101 , 114 ]. The least frequently measured outcome was the proportion of patients who received an opioid prescription refill ( n = 18) [ 57 , 68 ,…”

Section: Resultsmentioning

confidence: 99%

“…The proportion of patients using opioids was the second most frequently used outcome measure in the selected studies ( n = 25) [ 5 , 53 , 57 , 58 , 62 – 65 , 67 , 69 , 72 , 73 , 78 , 81 , 86 , 94 , 96 , 100 , 101 , 105 , 107 , 109 , 112 , 114 , 134 ] and this evaluation was often conducted at 3 ( n = 13) [ 5 , 53 , 57 , 62 , 63 , 65 , 72 , 81 , 94 , 100 , 105 , 112 , 114 ] and 6 months ( n = 6) [ 64 , 67 , 78 , 101 , 114 ]. The least frequently measured outcome was the proportion of patients who received an opioid prescription refill ( n = 18) [ 57 , 68 , 79 – 81 , 83 , 89 – 92 , 96 , 97 , 102 , 103 , 105 , 108 , 110 , 111 ] at 1 and 3 months. None of the studies measured illicit opioid use or opioid diversion (i.e., opioid diverted from siblings who have legitimate prescriptions).…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies measured illicit opioid use or opioid diversion (i.e., opioid diverted from siblings who have legitimate prescriptions). Data came from patient records or clinical-administrative databases ( n = 27) [ 5 , 60 , 73 , 74 , 78 – 81 , 83 – 89 , 91 , 94 , 98 , 101 – 105 , 108 , 110 , 112 , 114 ], or a combination of these methods, and from patient self-report ( n = 17) [ 53 , 55 , 58 , 62 , 63 , 65 , 68 , 71 , 72 , 77 , 82 , 90 , 96 , 100 , 107 , 109 , 113 ] in many studies. The remaining studies measured outcomes from self-reported data only ( n = 5) [ 50 , 54 , 67 , 69 , 95 ] or did not clearly describe the data source ( n = 17) [ 51 , 52 , 56 , 57 , 59 , 61 , 64 , 66 , 70 , 75 , 76 , 92 , 93 , 97 , 99 , 106 , 111 ].…”

Section: Resultsmentioning

confidence: 99%

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Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

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Background Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area. Methods This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines. Results A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence. Conclusions This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in trauma patients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

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Endogenous opiates and behavior: 2021

Bodnar

2023

Peptides

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Changes in opioid prescription duration for musculoskeletal injury associated with the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act

et al. 2023

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Objectives To assess whether implementation of the Strengthen Opioid Misuse Prevention (STOP) Act was associated with an increase in the percent of opioid prescriptions written for 7 days or less among patients with acute or post-surgical musculoskeletal conditions. Design An interrupted time series study was conducted to determine the change in duration of opioid prescriptions associated with the STOP Act. Setting Data were extracted from the electronic health record of a large healthcare system in North Carolina. Subjects Patients presenting from 2016-2020 with an acute musculoskeletal injury and the clinicians treating them were included in an interrupted time series study (n = 12,839). Methods Trends were assessed over time, including the change in trend associated with implementation of the STOP Act, for the percentage of prescriptions written for seven days or less. Results Among patients with acute musculoskeletal injury, less than 30% of prescriptions were written for 7 days or less in January of 2016; by December of 2020, almost 90% of prescriptions were written for 7 days or less. Prescriptions written for ≤ 7 days increased 17.7% after STOP Act was implemented (p < 0.001), after adjusting for the existing trend. Conclusions These results demonstrate significant potential for legislation to influence opioid prescribing behavior.

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The impact of state-mandated opioid prescribing restrictions on prescribing patterns surrounding reverse total shoulder arthroplasty

Cited by 5 publications

References 27 publications

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Endogenous opiates and behavior: 2021

Changes in opioid prescription duration for musculoskeletal injury associated with the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act

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