Patterns of postoperative opioid dispensing among Medicaid beneficiaries, 2016-2017 and 2021-2022

Although several opioid prescribing recommendations and guidelines have been published since 2016, patterns of postoperative opioid prescribing for specific procedures among Medicaid beneficiaries and guideline concordance remain unclear. This study examined and compared patterns of procedure-specific opioid prescribing for postoperative pain during 2016-2017 and 2021-2022. This study used MarketScan Multi-State Medicaid database to identify patients aged 0-64 years without a diagnosis of cancer who underwent one of 24 common surgical procedures between October 2016-September 2017 (n=267,142) and October 2021-September 2022 (n=223,647). For each procedure, 1) opioid dispensing rate; 2) days' supply of the opioid prescription; and 3) prescribed daily dosage in morphine milligram equivalents (MMEs) were measured. A total of 274,031 common surgical procedures were identified among Medicaid beneficiaries in 2016-2017 (n=267,142, 84.9% female, 78.5% aged 19-64, 52.3% White, 30.0% Black, 4.3% Hispanic) and 229,514 procedures in 2021-2022 (n=223,647, 84.7% female, 85.0% adults aged 19-64, 54.3% White, 27.1% Black, 8.3% Hispanic). Compared to procedure-specific opioid dispensing rates in 2016-2017 (range: 30.7%-94.5%), rates in 2021-2022 decreased across all procedures (range: 8.1%-84.4%). Mean days' supply of opioids for all procedures was shorter in 2021-2022 (range: 3.7-6.7 days) than in 2016-2017 (range: 4.2-9.2 days). Mean daily dosage of opioids decreased among 23 procedures. Only tonsillectomy had a lower mean daily dosage in 2016-2017. Overall, dispensing rates of opioids decreased in 2021-2022 compared to 2016-2017 across all procedures. In 2021-2022, both the mean day's supply and mean daily dosage of postoperative opioids for all 24 procedures were more concordant with recommendations in clinical guidelines. PERSPECTVE: This study examines and compares opioid prescribing for postoperative pain among Medicaid beneficiaries undergoing 24 common surgical procedures in 2016-2017 and 2021-2022. The observed decrease in opioid dispensing rates, days' supply, and daily dosages in 2021-2022 may indicate clinicians followed clinical guidelines more closely and improved postoperative opioid use safety.