Quantity of Initial Post-Surgical Opioid Prescriptions Went Up After DEA Action
Increasing restrictions on opioid prescribing after common elective surgeries did not have the desired effect, a new study finds. Instead, quantities in the initial prescriptions went up, not down. What do researchers suggest for future government efforts to limit the amount of opioids prescribed?
ANN ARBOR, MI – In a case of unintended consequences, a federal policy to limit opioid prescribing actually resulted in an increase in the painkillers received with the initial prescription after surgery.
That's according to a new report in JAMA Surgery, which details how, in 2014, the U.S. Drug Enforcement Administration shifted hydrocodone from schedule III to the more restrictive schedule II. That meant that commonly prescribed formulations of hydrocodone were limited to a 90-day supply and could no longer be prescribed by telephone or fax.
University of Michigan-lead researchers looked at how the action affected opioid prescriptions filled by about 22,000 privately insured adult patients who had common elective surgical procedures from 2012 to 2015 in Michigan. The study team analyzed insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan, specifically looking at opioid prescriptions filled within 14 days of discharge to home after surgery.
Defined as the primary outcome was a change in trends of the amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of Oct. 6, 2014. The investigators also looked at the total amount of opioids filled and the refill rate for the 30-day postoperative period. Subgroup analyses were performed by hydrocodone prescriptions, non-hydrocodone prescriptions, surgical procedure, and prior opioid use.
Analyzing the data involving 75 hospitals and 5,120 prescribers, the researchers determined that the mean OMEs filled in the initial opioid prescription increased by about 35 OMEs (β = 35.1 [13.2]; P < .01), equivalent to seven tablets of 5 mg hydrocodone. No significant differences in the total OMEs filled during the 30-day postoperative period before and after the schedule change (β = 18.3 [30.5]; P = .55) were detected, although there was a significant decrease in the refill rate (β = −5.2% [1.3%]; P < .001).
"Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors," study authors point out.
They suggest that future efforts to curb opioid prescribing should be combined with prescriber education and close follow-up to ensure that reductions in opioid prescribing actually occur.