Minn. ó Nearly a third of patients responding to a Mayo
Clinic survey said they used none of the opioids they were
prescribed after surgery. The research findings, presented
April 19 at the American Surgical Association annual meeting,
also show that only about 8 percent of patients disposed of
their remaining opioids.
researchers also found that:
discharge, 92 percent of patients received an opioid
the opioids prescribed, 63 percent went unused.
Ninety percent of patients were satisfied with their pain
Twenty-eight percent said they were prescribed too many
opioids, while 8 percent said they were prescribed too few.
median amount of opioids consumed per patient equaled about
six pills of 5-milligram oxycodone.
number of opioids patients needed after discharge also varied
significantly depending on the type of surgery. To conduct the
research, a cross-specialty team of physicians and researchers
surveyed 1,907 patients who underwent 25 common surgeries at
three academic medical centers. "This research provides a
road map for physicians and surgical departments. It shows
there are certain surgeries and types of patients who are
likely receiving significantly more opioids than needed,"
says Elizabeth Habermann, Ph.D., who is the senior author.
Habermann is the Robert D. and Patricia E. Kern Scientific
Director for Surgical Outcomes.
addition, the findings identify factors that can help develop
guidelines and optimize opioid prescriptions patients receive
after surgery. Based on this research and the teamís
previous findings, Mayo Clinic has implemented evidence-based
opioid prescribing guidelines specific to surgical areas,
beginning with the Department of Orthopedic Surgery. There,
the guidelines already have led to a considerable reduction in
opioid prescriptions. As one example, the median amount
prescribed dropped by half for total knee and total hip
new Mayo Clinic guidelines allow prescribers to tailor their
prescribing to address the needs of patients who need very
little or no opioids, along with those who need more pain
control, while still optimizing and reducing prescribing
across the board," says lead author Cornelius Thiels, D.O.,
a general surgery resident in the Mayo Clinic School of
Graduate Medical Education.
factors associated with a lower use of opioids include older
age, no history of anxiety, and a lower pain score at
discharge. Factors that could potentially predict the need for
more opioids include those younger in age, a history of
anxiety and a higher pain score at discharge.
prescribing guidelines should be based on evidence,
considering patient factors and the type of procedure, but
also allowing for prescriber discretion," Habermann says.
"This research and numerous other opioid prescribing
projects at Mayo Clinic are about identifying the best
approach for each individual patient, whether thatís
increasing, decreasing or maintaining prescription
researchers also suggest that the current one-size-fits-all
maximums for opioid prescribing that are being advocated by
many prescription drug plans and legislators to treat acute
pain may not be in patientsí best interest.
are not patient-centered and may inadvertently encourage both
over- and under-prescribing," Thiels says. "This
highlights to us the importance of developing
procedure-specific, evidence-based discharge opioid
researchers add that when patients donít dispose of their
excess opioids, more of the drugs are available for potential
use by others who didnít receive the prescription,
contributing to the opioid issues facing the U.S. They say
reducing prescriptions, when appropriate, and educating
communities on proper disposal will reduce that risk.
prescription totals in the U.S., while decreasing from 2011 to
2015, were still three times higher in 2015 than in 1999,
according to the newest data from Centers for Disease Control
and Prevention. And from 1999 to 2016, the number of opioid
overdose deaths increased fivefold, the CDC says.
complete manuscript of this study and its presentation at the
American Surgical Associationís 138th annual meeting is
anticipated to be published in the Annals of Surgery, pending