Wide Variation in Opioid Prescribing for Pain Relief Following Knee Arthroscopy

PainRelief.com: What are the main findings?

Response: Using data from 2015 to 2019 we found wide variation in the rate of post-operative opioid prescribing for patients who were opioid-naïve undergoing knee athrsocopy and the dosage of the prescription across states, even after adjusting for patient characteristics. Over 70% of patients filled opioid prescriptions after surgery containing an average of 40 pills, significantly more than what patients have reported needing.

We also found high tablet counts dispensed after the procedures for some states and much less for others. This is concerning, and somewhat surprising, given that the data covers 2015-2019, a period in which the negative effects of opioid initiation have been widely documented and publicized.

PainRelief.com: What should readers take away from your report?

Response: Given that emerging data show that many patients do not take prescribed opioids following knee arthroscopy, and if they do, most do well with 5 to 10 pills or less, there is a significant opportunity to reduce excessive prescribing. In the very rare cases patients need more, refill prescriptions can now be extended electronically in most states. This minor change in workflow can take thousands of unused opioids from entering the community, reduce the likelihood of transition to long-term use and family member overdose. It can help to set expectations pre-operatively and share with patients that most do well without opioids and or with a small amount and that using other medications such as acetaminophen and NSAIDs can be effective for managing pain after these procedures

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: More research is needed to describe the prescribing behavior in recent years for common low pain procedures. While policies have reduced opioid prescribing since its peak of dispensing in 2012, it is important to highlight areas care where opioid prescribing may be considered elevated relative to the expected pain experienced by the patient. Based on these data recommended prescribing guidelines can be established that argue for low opioid dosages or alternative treatments for procedures with low expected pain.

PainRelief.com: Is there anything else you would like to add?

Response: One aspect that always stands out to me is that healthcare is local, meaning that healthcare delivery differs by region and practice styles may contribute to the observed state variation in opioid prescribing. Additionally, our study doesn’t highlight the role of policies that may have already played an important role in reducing prescribing after knee arthroscopies, such as Prescription Drug Monitoring Programs (PDMPs). Though, most state policies are aimed at patients with a history of opioid use, and our study focuses on patients who do not have a history of opioid use.

Citation:
Ukert B, Huang Y, Sennett B, Delgado K. State-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015-2019. BMJ Open. 2020;10(8):e035126. Published 2020 Aug 20. doi:10.1136/bmjopen-2019-035126

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