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Patient-Based Decision Making for Opioid Prescriptions After Ambulatory Breast Operation: A Randomized Clinical Trial
Serena Y Lofftus1,2, Danielle S Graham1,2, Julie Le1,3
1UCLA Department of Surgery, Division of Surgical Oncology Los Angeles, CA 90095.
Journal of the American College of Surgeons
|April 13, 2026
Summary
A patient opt-in opioid strategy significantly reduced opioid prescriptions and consumption after breast surgery. This approach did not worsen patient pain or quality of life, offering a safer alternative.
Area of Science:
- Oncology
- Pain Management
- Surgery
Background:
- Opioid prescriptions are common after breast surgery, despite low reported pain.
- This practice increases the risk of opioid misuse and diversion.
- A patient-centered approach may mitigate these risks.
Purpose of the Study:
- To evaluate a patient opt-in opioid prescribing strategy.
- To determine its effect on opioid prescription, consumption, and excess.
- To assess its impact on postoperative pain and quality of life.
Main Methods:
- A randomized clinical trial compared the Postoperative Opt-In Opioid Treatment (POINT) strategy with routine prescribing.
- POINT involved patient education and opioids provided only upon request.
- Key outcomes included pain scores, opioid use, and quality of life (PROMIS-29).
Main Results:
- The POINT strategy reduced prescription rates by 65% and consumption by 15%.
- Opioid prescribing and excess pills were significantly lower in the POINT group.
- Peak pain scores and quality of life did not differ between groups.
Conclusions:
- A patient opt-in strategy effectively reduces opioid prescribing and consumption post-ambulatory breast surgery.
- This method maintains patient pain control and quality of life.
- It offers a promising strategy to curb the opioid crisis.
