Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery

Area of Science:

• Health Services Research
• Public Health
• Pain Management

Background:

• Postoperative opioid exposure poses a risk for new persistent opioid use, potentially leading to opioid use disorder and overdose.
• The effectiveness of evidence-based opioid prescribing guidelines in reducing this risk remains largely unknown.

Purpose of the Study:

• To evaluate the association between evidence-based opioid prescribing guidelines and the incidence of new persistent opioid use following surgery.
• To assess the impact of these guidelines on the total quantity of postoperative opioid prescriptions.

Main Methods:

• A difference-in-differences study design was employed using Medicare claims data.
• Opioid-naive patients undergoing one of six common surgical procedures were analyzed.
• The study compared outcomes in Michigan before and after the implementation of statewide opioid prescribing guidelines in October 2017, using patients outside Michigan as a control.

Main Results:

• Following guideline implementation in Michigan, the adjusted incidence of new persistent opioid use decreased by an additional 0.53 percentage points compared to control areas.
• The adjusted quantity of prescribed opioids (in oral morphine equivalents) decreased by an additional 55.7 mg OME in Michigan post-guidelines.
• Significant reductions were observed in both the incidence of new persistent opioid use and the total quantity of opioids prescribed.

Conclusions:

• Evidence-based opioid prescribing guidelines demonstrated a significant association with reduced new persistent opioid use after surgery.
• These guidelines were also effective in decreasing the overall quantity of opioids prescribed postoperatively.
• The findings support the widespread adoption of evidence-based guidelines to improve surgical pain management and mitigate opioid-related risks.