Surgery patients now less likely to receive opioids, but decline has slowed, study finds

Postoperative pain relief has shifted away from opioid-containing medications over the past seven years, but the downward trend has slowed since 2020, a new study shows.

Overall, the rate of surgery-related opioid prescriptions fell 36% between 2016 and the end of 2022, and the average amount of opioids in those prescriptions fell 46%, according to the pharmacy data study .

This combination of declines means that the total amount of opioids delivered to surgical patients at the end of 2022 was 66% lower than at the start of 2016, according to results published in Open JAMA Network by a team from the University of Michigan.

But the rate of decline was much faster before the pandemic, the researchers report after comparing opioid surgical models before and after 2020. That’s even after accounting for the unusual circumstances of spring 2020, when most Elective surgeries were temporarily paused to free up hospital capacity for COVID-19. 19 patients and reduce unnecessary exposure to the SARS-CoV-2 virus.

Even with the overall decline, patients undergoing surgery in the United States at the end of 2022 still received the equivalent of 44 5-milligram hydrocodone tablets from pharmacies after their surgery on average. This is far more than patients need for most procedures.

“These data suggest that surgical teams have significantly reduced opioid prescribing, but also suggest that efforts to tailor opioid prescriptions after surgery should continue,” said Kao-Ping Chua, MD, Ph. D., lead author of the new study and assistant professor of pediatrics at UM. He worked with first author and former UM research assistant Jason Zhang, who is now a medical student at Northwestern University.

The researchers also found that some types of surgeons reduced the amount of opioids delivered to patients more than others. For example, reductions were particularly significant in cardiothoracic surgery and ophthalmology.

Orthopedic surgeons still account for more than half of all surgical opioids dispensed to U.S. patients, even as the rate and size of prescriptions filled by their patients have declined.

Correct size prescription

The authors note that surgeons should not strive to completely eliminate opioid prescribing.

“The goal should be to ensure that opioids are only prescribed when necessary and that the amount of opioids prescribed matches the amount patients need,” Zhang said. “Achieving these goals could help reduce the risk of opioid abuse, persistent opioid use, and diversion of pills to people other than the patient.”

The risk of accidental exposure to opioids by other household members and interactions between opioids and other substances, including alcohol and prescription medications, are other reasons to focus on surgical care of non-opioid pain.

Chua and colleagues have repeatedly studied procedure-related opioid prescribing, including a recent study showing that the reduction in the rate of dental opioid prescribing has also slowed in recent years.

They worked with the Michigan Opioid Prescribing Engagement Network (OPEN) to develop prescribing guidelines for adult and pediatric surgical care.

Surgical organizations and the Centers for Disease Control and Prevention have advised surgeons to rely less on opioid-based acute pain relief for their patients since the mid-2010s. However, no studies have examined the trends in surgical prescribing of opioids using data from the pandemic era.

The new study is based on data from a company called IQVIA that tracks prescriptions dispensed at 92% of U.S. pharmacies.

In addition to Chua and Zhang, study authors include OPEN co-directors Jennifer Waljee, MD, MPH, MS, and Chad Brummett, MD. All except Zhang are members of the UM Institute for Healthcare Policy and Innovation, and Brummett co-directs the UM Opioid Research Institute.