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Author Notes:

Sunil Agarwal, MD, Michigan Opioid Prescribing Engagement Network, 2800 Plymouth Rd, North Campus Research Complex (NCRC) Bldg 16, Ann Arbor, MI 48109 Email: asuni@med.umich.edu

Drs Agarwal and Waljee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: All authors. Acquisition, analysis, or interpretation of data: Agarwal, Bryan, Hu, Lee, Chua, Haffajee, Brummett, Waljee. Drafting of the manuscript: Agarwal, Bryan, Chua, Brummett, Waljee. Critical revision of the manuscript for important intellectual content: Agarwal, Hu, Lee, Chua, Haffajee, Brummett, Englesbe, Waljee. Statistical analysis: Agarwal, Bryan, Hu, Chua. Obtained funding: Waljee. Administrative, technical, or material support: Agarwal, Bryan, Lee, Waljee. Supervision: Lee, Haffajee, Brummett, Englesbe, Waljee.

Dr Lee reported receiving grants from Blue Cross Blue Shield of Michigan Foundation during the conduct of the study. Dr Haffajee reported receiving grants from National Center for Advancing Translational Sciences of the National Institutes of Health and the Centers for Disease Control and Prevention for the University of Michigan Injury Prevention Center during the conduct of the study. Dr Brummett reported receiving grants from the University of Michigan and Michigan Opioid Prescribing Engagement Network and the US Department of Health and Human Services, Institutional–Precision Health Initiative, Opioid Use Case, receiving grants from the National Institutes of Health National Institute on Drug Abuse Prevention of Iatrogenic Opioid Dependence After Surgery, and serving as a consultant for Heron Therapeutics during the conduct of the study; and receiving research funding from Neuros Medical Inc, serving as a consultant for Recro Pharma and Heron Therapeutics, and holding a patent for peripheral perineural dexmedetomidine licensed to the University of Michigan outside the submitted work. Dr Englesbe reported receiving grants from Blue Cross and Blue Shield of Michigan during the conduct of the study. Dr Waljee reported receiving grants from National Institutes of Health and grants from the Michigan Department of Health and Human Services during the conduct of the study and being an unpaid consultant for 3M Health Information Systems outside the submitted work. No other disclosures were reported.

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Research Funding:

Dr Waljee receives funding from the National Institute on Drug Abuse (grant RO1 DA042859), National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant P50 AR070600), the Michigan Department of Health and Human Services (grant E20180672-00 Michigan DHHS - MA-2018 Master Agreement Program), the Substance Abuse and Mental Health Administration (grant SAMHSA: E20180568-00 MA-2018 Master Agreement Program), and the Centers for Disease Control and Prevention (grant E20182818-00 MA-2018 Master Agreement Program). Dr Chua is supported by a career development award from the National Institute on Drug Abuse (grant 1K08DA048110-01). Additional funding was provided by the University of Michigan School Dean's Office—Michigan Genomics Initiative and Precision Health Initiative, by the American College of Surgeons and the American Foundation for Surgery of the Hand (Dr Waljee), and by the Michigan Department of Health and Human Services (Drs Brummett, Waljee, and Englesbe).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • PRESCRIPTIONS
  • PAIN

Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

Tools:

Journal Title:

JAMA NETWORK OPEN

Volume:

Volume 2, Number 12

Publisher:

, Pages e1918361-e1918361

Type of Work:

Article | Final Publisher PDF

Abstract:

Importance: Since the Centers for Disease Control and Prevention published opioid prescribing guidelines in March 2016, 31 states have implemented legislation to restrict the duration of opioid prescriptions for acute pain. However, the association of these policies with the amount of opioid prescribed following surgery remains unknown. Objective: To examine the association of opioid prescribing duration limits with postoperative opioid prescribing in Massachusetts and Connecticut, the first 2 states to implement limits after March 2016. Design, Setting, and Participants: This interrupted time series analysis and cross-sectional study examined immediate level and slope changes in monthly outcomes after prescribing limit implementation in Massachusetts and Connecticut. These states implemented 7-day limits on initial opioid prescriptions on March 14, 2016, and July 1, 2016, respectively. Using the 2014 to 2017 IBM MarketScan Research Database, 16 281 opioid-naive adults in these states who filled a prescription within 3 days of surgery between July 1, 2014, and November 30, 2017, were identified. Data were analyzed from December 2018 to June 2019. Main Outcomes and Measures: The primary outcome was the prescription size in oral morphine equivalents (OMEs) for the initial postoperative opioid prescription (one 5/325 mg hydrocodone-acetaminophen pill = 5 OMEs). Secondary outcomes included days supplied in the initial prescription and the proportion of initial prescriptions exceeding a 7-day supply. Results: In total, 16 281 opioid-naive patients (9708 [59.6%] female; median [interquartile range] age range, 45-54 [35-44 to 55-64] years) undergoing surgical procedures were included. In Massachusetts, there were 5340 and 5435 patients in the preimplementation and postimplementation periods, respectively. In Connecticut, there were 2869 and 2637 patients in the preimplementation and postimplementation periods, respectively. Limit implementation in Massachusetts was associated with an immediate mean level decrease in prescription size (-38 OMEs [95% CI, -44 to -32 OMEs]) and with a mean decrease in slope (-1.5 OMEs/mo [95% CI, -2.1 to -0.9 OMEs/mo]). Implementation was also associated with an immediate mean level decrease in days supplied (-0.4 days [95% CI, -0.6 to -0.2 days]) and the proportion of prescriptions exceeding a 7-day supply (-5.9 percentage points [95% CI, -7.9 to -3.9 percentage points]). In contrast, limit implementation in Connecticut was not associated with level or slope changes in any outcome. Conclusions and Relevance: Opioid prescribing duration limits had a variable association with postoperative opioid prescribing in Massachusetts and Connecticut. The mean opioid prescription size filled, days supplied, and prescribing exceeding a 7-day supply decreased after limit implementation in Massachusetts only. Given the potential differences in policy dissemination and uptake, efforts to reduce opioid prescribing should also include surgeon education and evidence-based prescribing recommendations.

Copyright information:

2019 Agarwal S et al. JAMA Network Open.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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