Reducing the number of leftover pain relievers from post-surgical prescriptions could help in the fight against opioid addiction and trafficking.
A new study details how surgeons at the University of Michigan discovered a “spillover” effect after the development of prescribing recommendations based on published medical evidence for gall bladder removal. As a result, the surgeons began prescribing about 10,000 fewer pills for major operations, according to the study published in an article in the Journal of the American College of Surgeons.
Overprescribed opioids is a common occurrence after surgery, resulting in leftover pills that could fall into the wrong hands, according to researchers. The study looked at reviews of 1,158 patient charts — 558 of which shows operations that occurred before the opioid recommendations were in effect, with 600 surgeries taking place more than 10 months after the new guidelines.
Researchers found that for sleeve gastrectomy, the most extensive procedure, the average prescription post-surgery was 89 pills before the recommendations and 58 afterward. The number of pills prescribed for hernia repair went from 37 pills to 21 — a 43% reduction and 35 pills to 17 after an appendectomy — about a 50% reduction, according to the study.
Thyroidectomy/parathyroidectomy post-surgery prescriptions went from 16 pills to eight.
“We changed how many opioids we dispense or prescribe to patients after laparoscopic cholecystectomy, which is performed for gall bladder removal,” said lead study author Michael Englesbe, MD, FACS, a transplant surgeon in the department of surgery at University of Michigan Health System in Ann Arbor. “As an unintended spillover consequence, the change had a significant impact on how we prescribe for other procedures.”
These particular surgeries were chosen because they are not traditionally performed to treat pain and patients are expected to recover relatively quickly, Englesbe said. They also are straightforward, elective procedures commonly done across the U.S., he said.
Seniors support opioid prescription limits
A recent AARP and University of Michigan survey found a majority of older adults support limits on opioid prescriptions. Three in four seniors support limits on the total number of days and pills that can be prescribed, according to the poll. Fewer than half of seniors support guidelines requiring the return of unused medications.
“The fact that so many older adults report having leftover opioid pills is a big problem, given the risk of abuse and addiction with these medications,” Alison Bryant, senior vice president of research at AARP, said in a July 30 article on the AARP website. “Having unused opioids in the house, often stored in unlocked medicine cabinets, is a big risk to other family members, as well. These findings highlight the importance of improving older adults’ awareness and access to services that will help them safely dispose of unused opioid medications.”
Following the original recommendations for prescribing opioids post-gall bladder removal, the Michigan Surgical Quality Collaborative and Opioid Prescribing Engagement Network developed recommendations for 17 other procedures, including three types of hysterectomy, breast biopsy and mastectomy. View the full list of recommendations here.