No Change in Number of Post-Op Opioid Prescriptions, But Dosages Drop

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New research out of Canada offers some encouraging news amid concerns about the opioid epidemic.

Doctors are prescribing a lower dose of the painkillers after older adults have surgery, the study found. They are not, however, writing fewer prescriptions for the potentially addictive drugs.

“While it’s good news that the doses in opioid prescriptions are being reduced, the fact that the actual number of opioid prescriptions filled has remained the same shows there is still an opportunity for improvement,” said study author Dr. Naheed Jivraj, a fellow in critical care medicine at the University of Toronto.

“That’s particularly true for procedures associated with low postoperative pain that can be effectively controlled with non-opioid medications such as acetaminophen and nonsteroidal anti-inflammatory drugs [NSAIDs],” Jivraj said.

His team studied records of more than 278,000 people in Ontario who were older than 65 when they had one of 14 surgical procedures between 2013 and 2019.

Their procedures included removal of the thyroid, appendix, gallbladder, prostate, colon and breast, as well as hernia repair, open-heart surgery, hysterectomy and hip and knee replacement.

During the study period, more patients filled prescriptions for non-opioid pain relievers such as acetaminophen or a nonsteroidal anti-inflammatory drug. The percentage rose from 9% in 2013 to 28% in 2019.

Most of patients also received a prescription that contained an opioid. In 2013, 76% received an opioid prescription, as did 75% in 2019.

Over that time, the average dose dropped from 317 MME (morphine milligram equivalent) to an average 260 MME.

Patients who have certain procedures, such as appendix or thyroid removal, can typically relieve their pain with acetaminophen or an NSAID. Yet the study found that few patients who had these procedures filled prescriptions for those non-opioid alternatives.

The findings were presented Saturday in New Orleans at a meeting of the American Society of Anesthesiologists.

Limiting use of opioids is important because they can have major side effects, lead to addiction and cause a potentially deadly overdose.

“Our study highlights how pain management practices are changing after surgery,” Jivraj said in a meeting news release.

“The increase in seniors filling non-opioid prescriptions and the lower opioid dose may reflect the development of surgery-specific prescribing guidelines and the increasing use of anesthesiologist-championed Enhanced Recovery After Surgery protocols and other programs that focus on improving patient outcomes,” he noted.

Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

More information

The U.S. Department of Health and Human Services has more on the opioid epidemic.

SOURCE: American Society of Anesthesiologists, news release, Oct. 22, 2022

Source: HealthDay

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