J. S. Lee1, C. M. Brummett2, J. F. Waljee1, M. J. Englesbe1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Department Of Anesthesiology,Ann Arbor, MI, USA
Introduction:
Although recent studies have suggested opioid prescribing is declining, opioid-related mortality continues to rise. Opioid prescriptions for acute pain play a crucial role, serving as a gateway to chronic use and a source of unused opioids for diversion. To identify potential opportunities to reduce excess opioid prescriptions for acute pain, we evaluated trends in opioid prescribing over time between surgeons and Emergency Medicine physicians. We hypothesized that opioid prescribing would increase in surgical specialties due to a lack of effective strategies for changing practice.
Methods:
Using the Medicare Part D Prescriber Public Use File, we identified surgeons and Emergency Medicine physicians with claims for opioid prescriptions from 2013 – 2015. Prescriber specialty was identified by National Provider Identifier codes. Our primary outcome measure was the number of days supplied for an individual opioid prescription, a parameter frequently restricted by legislation targeting opioid prescriptions for acute pain. We then calculated the average days supplied each year for surgeons and Emergency Medicine physicians. Differences in mean days supplied were evaluated using t-tests. We also calculated the percent change in mean days supplied compared to 2013 levels.
Results:
Between 2013 and 2015, 20.7 million opioid prescriptions were provided by surgeons, while 7.5 million opioid prescriptions were provided by Emergency Medicine physicians. For opioid prescriptions provided by surgeons, the number of days supplied per prescription rose by 3% (Figure 1) from 2013 to 2015 (7.7 vs. 7.9 days, p < 0.001). In contrast, for prescriptions provided by Emergency Medicine physicians, days supplied decreased by 5% (5.0 vs 4.7 days, p <0.001).
Conclusion:
In recent years, the average days supplied for opioid prescriptions provided by surgeons has increased by 3%, but has declined by 5% for Emergency Medicine physicians. This may be due to earlier implementation of strategies in Emergency Medicine, such as the American College of Emergency Physicians Clinical Policy on Opioid Prescribing in 2012. With recent studies showing surgical opioid prescriptions far exceed patient needs, surgeons must develop more effective strategies to change practice for opioid prescribing.
