Abstract
Background
In response to the growing opioid crisis, Florida recently implemented a law restricting
the duration of opioid prescriptions for acute pain. Little is known about the impact
of such legislation on opioid prescription practices at the time of discharge after
surgery. The objective of this study was to determine whether Florida’s new legislation
changed opioid prescription practices for analgesia after surgery.
Methods
Adults 18 years of age and older undergoing cholecystectomy, appendectomy, hernia
repair, hysterectomy, mastectomy, or lymph node dissection were included in this retrospective
cohort study at a large public university–affiliated hospital. We analyzed opioid
prescriptions on discharge after these common outpatient surgical procedures between
June 1, 2017, and December 31, 2018. Florida House Bill 21 was passed on March 2,
2018, and subsequent implementation of this law took place on July 1, 2018. The law
restricts the duration of opioid prescriptions for acute pain to 3 days, which can
be extended up to a maximum of 7 days with additional documentation. The outcomes
studied included the following: the proportion of patients receiving opioid prescriptions
on discharge, total opioid dose prescribed, daily opioid dose prescribed, and the
proportion of patients receiving more than a 3-day supply of opioids. We colledted
data on emergency department cumulative visits within 7 and 30 days after discharge.
Drug doses were converted to morphine milligram equivalents and calculated for each
selected procedure.
Results
A total of 1,467 surgical encounters were included. The cohort was predominantly female
(963 [65.6%]) with a mean (SD) age of 49.6 (14.4) years. At 6 months after implementation
of HB 21, the proportion of patients receiving opioid prescriptions decreased by 21%
(95% CI 16.8% to 25.3%, P < .001), mean total opioid dose prescribed decreased by 64.2 morphine milligram equivalents
(95% CI 54.7 to 73.7, P < .001) from a baseline mean (SD) of 172.5 (78.9) morphine milligram equivalents.
The mean daily opioid dose prescribed increased by 3.5 morphine milligram equivalents
(95% CI 1.8 to 5.1, P < .001) from a baseline mean (SD) of 30.5 (9.4) morphine milligram equivalents. The
proportion of patients receiving opioid prescriptions for longer than a 3-day supply
decreased by 68% (95% CI 63.4% to 72.7%, P < .001). We observed no change in the number of postoperative emergency department
visits before and after implementation of the law.
Conclusion
Opioid prescriptions for patients undergoing common outpatient surgical procedures
at a large public university–affiliated hospital in Florida were substantially reduced
within 6 months after implementation of state legislation limiting the duration of
opioid prescriptions. This reduction was not associated with an increase in the number
of postoperative emergency department visits. The legislation should significantly
decrease the amount of unused opioid pills potentially available for diversion and
abuse. Secondary effects from the enactment of this law remain to be evaluated.
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Article Info
Publication History
Published online: June 10, 2019
Accepted:
April 23,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
