In a study published online by JAMA, Hannah Wunsch, M.D., M.Sc., of Sunnybrook Health Sciences Centre, Toronto, and colleagues assessed trends in the amount of hydrocodone/acetaminophen and oxycodone/acetaminophen prescribed from 2004-2012, two opioids commonly used for postoperative pain management.
The study included health care encounters of approximately 14 million primarily commercially insured patients, with information on pharmacy and medical claims with data on services and procedures. The sample included opioid-naive adults (n = 155,297) who underwent 1 or more of 4 low-risk surgical procedures in 2004, 2008, or 2012: carpal tunnel release, laparoscopic cholecystectomy (gallbladder removal), inguinal hernia repair, or knee arthroscopy. The researchers assessed the proportion of patients who filled any opioid prescription (and specifically hydrocodone/acetaminophen or oxycodone/acetaminophen) in the 7 days after hospital discharge (inpatients) or on the procedure date (outpatients).
Within 7 days, 80 percent filled a prescription for any opioid, and 86 percent of these prescriptions were for hydrocodone/acetaminophen or oxycodone/acetaminophen. The proportions of patients filling prescriptions for any opioid and for hydrocodone/acetaminophen and oxycodone/acetaminophen increased over time for all surgeries. The average morphine equivalent dose increased over time for all procedures examined, with an increase of 18 percent for patients undergoing knee arthroscopy, driven by a change in the average daily dose.
“Because the cohort was restricted to opioid-naive individuals, these changes are unlikely to represent an appropriate response by prescribing physicians to increasing rates of opioid tolerance over time within the population. Possible explanations include an increased focus on pain treatment or an increasing reliance on opioids for postoperative pain relief vs alternative therapies,” the authors write.
“Further research should assess the contribution of postoperative opioid prescribing practices to the epidemic of prescription opioid-related abuse.”