Opioid Prescribing: Government Rules PLUS Institutional Initiatives=Better Results

Elizabeth Hofheinz, M.P.H., M.Ed.

When researchers from NYU Langone Health reviewed data on 20,483 patients who underwent orthopedic procedures, they found that adding institutional initiatives to state regulations went a long way toward reducing the amount of opioids prescribed to these patients in the perioperative period. Their resulting study, “Opioid Prescribing Patterns in Orthopaedic Surgery Patients: the Effect of New York State Regulations and Institutional Initiatives,” was published in the December 15, 2020 edition of the Journal of the American Academy of Orthopaedic Surgeons.

For this retrospective review, the electronic medication orders for all patients who underwent orthopaedic surgery between September 2015 and June 2018 at NYU Langone were assessed. The team looked at outcome the number of patients prescribed opioids, the duration of prescription (days), the mean milligram morphine equivalent (MME), and the percentage of patients prescribed both opioids and benzodiazepines.

The researchers divided patients into three time cohorts. The first was September 2015 to July 2016 (prior to the opioid reduction effort), the second was August 2016 to May 2017 (the period immediately after the beginning of the New York State 7-day prescription limit for acute pain). The third time cohort, June 2017 to June 2018, was the period after the initiation of the Continuing Medical Education (CME) educational mandate in New York State. During the third cohort, say the authors, the NYU Langone department of orthopaedic surgery also initiated “an opioid sparse pain protocol for arthroplasty patients and institutional resources were expanded to encourage multimodal pain control across all orthopaedic patients.”

Co-author Ariana Lott, M.D. is a Resident Physician in the Department of Orthopedic Surgery at the NYU School of Medicine at NYU Langone Health. Dr. Lott told OSN, “The exciting surprise in this study was that with the introduction of the CME requirement and institutional initiative, the number of patients who were even prescribed opioids decreased by over 10%. This means that not only was each patient receiving less opioid medication with each prescription, but a greater number of patients were not even using opioids for post-operative pain control, which is important in fighting the opioid epidemic.”

“With the initiation of the New York State 7-day supply legislation, there was a decrease in average supply of opioids prescribed from 10.1 to 7.6 days and in average daily MME prescribed from 67.9 to 56.7 mg. The average supply of opioids decreased even further with the combination of physician education and surgeon-led institutional initiatives to a mean of 6.4 days. Furthermore, even with a shorter duration of prescription, the average daily MME decreased to 51.2 mg.”

“This research highlights the impact of institutional-led initiatives and educational resources in combination with governmental policies in reducing opioid prescribing. These findings suggest that in order to help patients and improve the opioid crisis in our country, physicians need to work together with state and local officials to develop strategies in order to reduce the quantity of opioids being prescribed. Emphasis should be on how to further opioid-sparing post-operative pain protocols to rely less on opioid medications in this surgical patient population.”