Factors orthopaedic surgeons should consider when prescribing opioids

June 26, 2019

Orthopaedic surgeons are the third-highest physician prescribers of opioids, writing more than 6 million prescriptions a year. Because over-dispensing of opioids is a factor contributing to the ongoing opioid epidemic, researchers at Johns Hopkins surveyed orthopaedic providers to better understand what drives their prescribing practices and to identify gaps in knowledge and potentially worrisome trends. In their survey of 127 orthopaedic providers in the Baltimore area, the Johns Hopkins researchers found that respondents frequently recommended prescribing a nine-day supply of around-the-clock oxycodone doses following commonly performed orthopaedic surgeries. The researchers also found that risk factors that might normally warrant prescribing fewer opioids, such as a history of drug misuse or depression, often did not diminish hypothetical prescribing rates.

The researchers published their findings on June 22 in the Journal of Opioid Management.

In the survey, researchers gauged responses to six scenarios routinely encountered by orthopaedic surgeons. They found that although increased experience was associated with decreased prescribing, 95% of respondents recommended prescribing at least 55 oxycodone pills following five of the six surgeries described. That amounts to a nine-day supply of medication, more than current recommendations from the Centers for Disease Control (issued since the survey was conducted) that no more than a three- to seven-day supply routinely be prescribed. In addition, comparing this result with recent studies looking at opioid use after orthopaedic surgery suggests that this number of doses was more than what is usually required to adequately treat post-operative pain.

The study also found that 62% of respondents reported that they do not routinely use their state-sponsored electronic prescription drug-monitoring program, which can help flag when patients go "doctor shopping" for a new source of pills. Finally, 79% of respondents reported that they do not provide opioid disposal instructions to their patients, which researchers are concerned can lead to unused pills remaining in homes and potentially getting into the wrong hands.

"Our findings show that there are clear knowledge gaps among orthopaedic surgeons for best practices for prescribing opioids that can and should be addressed," says lead author Constance Monitto, M.D., assistant professor of anesthesiology and critical care medicine and director of the pediatric acute pain service. "Evidence-based guidelines for opioid prescribing for specific procedures are also needed to curb overprescribing while still adequately treating pain."

Monitto notes that since the time the study was performed, Johns Hopkins has created a committee to help establish prescribing guidelines specifically for routine surgical procedures, and an additional group is developing educational materials for patients on safe handling and disposal of medications. She says other hospitals and health care centers should follow suit in order to curb overprescribing and decrease the risk of patient harm.
-end-


Johns Hopkins Medicine

Related Opioids Articles from Brightsurf:

One in 10 older dental patients inappropriately prescribed opioids
A new study by researchers at the University of Illinois Chicago and the University of Pittsburgh suggests that a significant proportion of older patients receiving opioids at dental visits also use psychotropic medications -- a potentially harmful combination.

Look beyond opioids to solve national substance use epidemic, study suggests
A new study published reveals that three-quarters of participants in an inpatient addiction intervention program at Oregon Health & Science University came into the hospital using more than one substance.

Placenta can indicate how body responds to opioids during pregnancy
Scientists at the University of Missouri have discovered possible biological markers that they hope could one day help identify the presence of an opioid use disorder during human pregnancy.

Research Finds Women Often Overprescribed Opioids After Childbirth
Excessive opioid prescriptions following childbirth may lead to higher rates of addiction within communities, according to a new report in The Journal of the American Osteopathic Association.

Women significantly more likely to be prescribed opioids, study shows
Women are significantly more likely to receive prescriptions of opioid analgesics.

Opioids for chronic non-cancer pain doubled in quarter century
A review of 24 years of global research has shown opioid prescribing doubled between 1991-2015, with demand most common for chronic conditions such as chronic lower back pain, finds University of Sydney-led research.

Cancer screening among women prescribed opioids
US women who take prescription opioids are no less likely to receive key cancer screenings when compared to women who are not prescribed opioids.

Parents: Turkey makes great leftovers -- opioids do not
Leftover prescription opioids pose big risks to kids, yet most parents keep their own and their child's unused painkillers even after they're no longer medically necessary for pain.

Co-addiction of meth and opioids hinders treatment
A study published in the Journal of Substance Abuse Treatment found that methamphetamine use was associated with more than twice the risk for dropping out of treatment for opioid-use disorder.

Computer game may help to predict reuse of opioids
A computer betting game can help predict the likelihood that someone recovering from opioid addiction will reuse the pain-relieving drugs, a new study shows.

Read More: Opioids News and Opioids Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.