Use of post-discharge opioid consumption patterns as a tool for evaluating opioid prescribing guidelines

Trial of the Patient-Centered 2 × 24-Hour Predischarge Opioid Consumption Opioid Prescribing Guideline

“…Our group and others have previously advocated for patient-centered opioid prescribing guidelines. 5,6 This study validates a simple, patientcentered guideline (2 × 24-hour PDOC), which may help further decrease the number of opioids being prescribed without compromising patient pain control.…”

“…Categorical variables were summarized with percentages using a χ 2 test, while continuous variables were summarized as medians and IQRs using a Wilcoxon rank sum test. To estimate conditional median of the outcomes, Conclusions | We have previously demonstrated 5 that patients in control groups received similarly sized prescriptions as those recommended by most national opioid prescribing guidelines. This study shows that even smaller opioid prescriptions are adequate for most patients and lead to decreased numbers of leftover opioids available for opioid abuse, misuse, or diversion among surgical patients and their communities.…”

A prospective feasibility study evaluating the 5x-multiplier to standardize discharge prescriptions in cancer surgery patients

“…It also removes the guesswork of the "optimal" time of weaning off opioids, which can range from only a few days to 2 weeks [ 26 ]. Bleicher et al have published studies evaluating both "2x" and "4x" multipliers for patient-centered opioid prescribing practices [ 13 , 27 ]. In the present study, we found that there were nearly twice as many patients receiving zero opioids at discharge in the 5x arm (33.5%) in comparison to the UC arm (18.0%).…”

Finding the Balance Between Reduced Opioid Prescribing and Patient-reported Pain Management Among General Surgery Patients

“…It is likely that more patients who have no risk factors for poor pain control and undergo procedures associated with low postoperative opioid requirements could be discharged without an opioid prescription, similarly ensuring appropriate predischarge education on optimal nonopioid pain medication utilization and information on when and how to contact the surgical team if pain control is inadequate. For patients who are admitted following surgery, in-hospital opioid use appears to be a good metric to determine postdischarge needs and may be particularly helpful in determining which patients will do well without an opioid prescription 15,29,30 …”

“…For patients who are admitted following surgery, in-hospital opioid use appears to be a good metric to determine postdischarge needs and may be particularly helpful in determining which patients will do well without an opioid prescription. 15,29,30 The study has several strengths, including the prospective nature, the variety of general surgery procedures included, and the high survey response rates. However, it also has several limitations, starting with its generalizability.…”