Mandatory Prescription Limits and Opioid Use After Anterior Cruciate Ligament Reconstruction

Because of the need for perioperative pain management, orthopaedic surgeons play an important role in opioid use.

To evaluate the impact of opioid-limiting legislation on postoperative opioid use and pain-related complications after anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the opioid-limiting legislation would reduce postoperative opioid use after ACLR.

Cohort study; level of evidence, 3.

We retrospectively reviewed patients who underwent ACLR 1 year before and 1 year after Ohio's opioid-limiting legislation, which was passed in August 2017. Clinicians were prohibited from prescribing more than 30 morphine milligram equivalents (MMEs) per day, with a maximum duration of 7 days for adults. The Ohio Automated Rx Reporting System database and patients' medical charts were reviewed for prescriptions of all controlled substances (oral oxycodone, hydrocodone, morphine, codeine, tramadol, and hydromorphone) filled from 30 days before and 90 days after ACLR. The total number of postoperative prescriptions, total MMEs, the number of pills in each patient's prescription, and pain-related complications (emergency department visits, office calls for pain control issues, unplanned readmissions, unplanned surgeries, and provider notes indicating opioid prescription refill demands) were evaluated.

A total of 243 patients (127 prelegislation, 116 postlegislation) were included in the study. There were no significant differences in demographics or preoperative opioid use between the study groups. The number of pills prescribed initially decreased by 34% after legislation (63.5 ± 16.7 [prelegislation] vs 42 ± 15.7 pills [postlegislation]; P < .001). Correspondingly, there was a significant decrease in total quantity of initial prescriptions in the postlegislation period (474.6 ± 123.8 vs 310.7 ± 115.3 MMEs; P < .001). The number of documented pain medication refill demands and pain-related complications did not increase in the postlegislation period (42 prelegislation vs 43 postlegislation; P = .514). Preoperative opioid use was the strongest predictor of opioid-refill demand (odds ratio, 4.19 [95% CI, 1.76-9.99]; P = .001).

After the Ohio legislation was passed limiting opioid prescription, there was a significant reduction in opioids provided for patients undergoing ACLR. In spite of this decrease, no rebound increase in refill demands or postoperative pain-related complications were observed.