The proportion of patients in the United States receiving postsurgical opioids exceeding recommended thresholds increased between 2006 and 2015

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  • September 5, 2023
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  • Young, Jessica
    • Affiliation: Cecil G. Sheps Center for Health Services Research
  • Chidgey, Brooke
    • Affiliation: School of Medicine
  • Stürmer, Til
    • Affiliation: Gillings School of Global Public Health
  • Jonsson-Funk, Michele
    • Affiliation: Gillings School of Global Public Health
Abstract
  • Background: Studies have found that patients routinely receive more opioids than medically necessary for adequate postsurgical pain management. This excess prescribing contributes to unused supply, increasing the risk of diversion and nonmedical use. In response to the US opioid crisis, opioid prescription (Rx) limits have been implemented on a state-by-state basis beginning in 2016, with 32 states currently enforcing prescribing limits. Objectives: Among a broad cohort of opioid-naïve surgical patients in the US, examine trends in 1) the proportion filling opioid Rxs for postsurgical pain, and 2) the initial volume prescribed. Methods: We identified patients undergoing surgery in MarketScan (2006–2015) and Medicare (2007–2015) claims. We defined the index opioid Rx for postsurgical pain as the first opioid filled in the week surrounding surgery following 180 days with no prior use. To reflect recent policy recommendations, we examined the proportion of patients whose index opioid Rx exceeded 7 days supply, 40 quantity dispensed (QTY), or 300 morphine milligram equivalents (MME). Results: We identified 5,148,485 opioid-naïve surgical patients in MarketScan (mean age = 45), of whom 2,957,115 (55%) received an index opioid (median: days supply = 5; QTY = 30; MME = 240). The proportion of all patients with an index opioid Rx increased from 51% in 2006 to 62% in 2013, followed by a decline to 42% in 2015. Among patients receiving an index opioid, the proportion receiving >7 days supply increased monotonically, nearly doubling between 2006 (11%) and 2015 (19%). Similarly, the proportion of patients receiving >40 QTY more than doubled throughout the study period, rising from 14% in 2006 to 29% in 2015, and the proportion receiving >300 MME rose from 21% in 2006 to 34% in 2015. Parallel analyses in Medicare found that the proportion receiving post-op opioids continued to increase through 2015, with parallel trends of increasing proportions of patients filling index opioid Rxs above defined thresholds throughout the study period. Conclusions: Between 2005 and 2013, there was an increase in both the probability of opioid receipt for postsurgical pain, and the proportion of Rxs exceeding recommended thresholds. While the proportion of patients filling opioids began to decline in 2014 among the MarketScan population, the proportion of high threshold Rxs continued to increase. Understanding trends in post-surgical prescribing are vital in informing and evaluating policies aimed at reducing unnecessary opioid exposure and curbing the opioid crisis in the US.
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