Providing surgical patients with a 3-day opioid supply at discharge decreased conversion to long-term opioid use, according to results of a prospective cohort study published in JAMA Oncology.
Opioids continue to be the standard approach to postoperative pain management in the United States despite the pattern of chronic opioid use in surgical patients.
This study evaluated the feasibility and outcomes of a restrictive opioid prescription protocol (ROPP). For this study, 2051 patients who underwent surgery at the Roswell Park Comprehensive Cancer Center in Buffalo, New York, February 1, 2019, to July 31, 2019, received a maximum 3-day opioid supply with one electronic refill (intervention cohort). The protocol’s effect on opioid use patterns were compared with a pre-ROPP (control) cohort of 2017 patients who underwent surgery August 1, 2018, to January 31, 2019.
The intervention and control cohorts comprised patients mean age 61.3 and 60.8 years, 61.0% and 63.3% were women, 64.3% and 66.8% underwent open surgery, 51.5% and 52.8% had minor surgery, respectively. The average length of hospital stay was 2.5 days for both cohorts.
The ROPP associated with a 45% decrease in prescribed opioids compared with pre-ROPP prescribing (mean morphine milligram equivalents [MME] 157.22 vs 83.54 mg; P <.001). Fewer patients in the post-ROPP cohort requested opioid refills (17.9%) than in the pre-ROPP cohort (20.9%; P =.02).
Conversion to long-term opioid use was decreased in the post-ROPP cohort compared with the pre-ROPP cohort among patients with cancer who were opioid naïve and patients who requested 1 or more (4.5% vs 11.3%; P <.001) or 2 or more (1.3% vs 4.5%; P <.001) opioid refills.
This study did not consider the effect of postsurgical adjuvant treatment.
The study authors concluded that providing patients with a 3- or fewer-day opioid supply in the postsurgical setting was feasible, led to fewer refill requests, and decreased the rate of conversion to long-term use among opioid-naïve patients.
Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Zsiros E, Ricciuti J, Gallo S, et al. Postoperative restrictive opioid protocols and durable changes in opioid prescribing and chronic opioid use. JAMA Oncol. Published online January 5, 2023. doi:10.1001/jamaoncol.2022.6278