New guidelines on prescribing fewer opioids could have massive impact: Study

Fewer opioids are being prescribed, which is just fine by patients.

August 16, 2019, 1:14 PM

Surgeons in Michigan are prescribing fewer opioid medications after operations, but here's the kicker: Their patients are not complaining.

A new study further explores whether too many opioids were being given to patients and how new guidelines can help surgeons curb usage without affecting pain relief.

In the study, opioid dosages often were decreased to 18 pills from 26 pills, with "no clinically important changes in pain scores."

"The results here are promising," said Dr. Joshua Sharfstein, co-author of "The Opioid Epidemic: What Everyone Needs To Know" and professor of practice at the Johns Hopkins Bloomberg School of Public Health. "Most [physicians] prescribe by routine, and changing those routines is hard. This shows that some changes are possible."

In the seven months after the guidelines were released, the number of prescriptions for fewer pills almost tripled, to 59% from 20%, according to the study. Many physicians prescribed about eight fewer pills, and patients consumed about three fewer.

The Michigan Surgical Quality Collaborative and the Michigan Opioid Prescribing Engagement Network reviewed data on how 50,000 patients took opioids for pain management. New guidelines were developed for surgeons on how to prescribe opioids for nine common surgeries including hernia repair and gallbladder removal.

About 12,000 patients were tracked across 43 hospitals. When more than half of those patients were interviewed about their pain levels, most didn't report feeling an increase in them and were satisfied with their care.

PHOTO: In this undated file photo, a team of doctors have a meeting.
In this undated file photo, a team of doctors have a meeting.
Getty Images, FILE

This study comes at an important time.

Opioid medications, which are highly addictive, are causing an epidemic in this country. The Centers for Disease Control and Prevention has determined that about 130 Americans die every day from overdosing on opioids.

Dr. Joceline Vu, one of the study's authors and a surgical resident at University of Michigan, thinks that these new guidelines can be a part of the solution.

"For healthy people, surgery may be the first time they are exposed to opioids," she told ABC News. So if people unfamiliar with taking opioids are given more than required, that person could become dependent on them, she added. Or the pills could find their way into the community.

Sharfstein agreed with Vu, adding that this is one part of a large and complex problem.

Before these guidelines, Vu said there wasn't a systematic way for surgeons to determine how many pills to give to patients when they're released from the hospital. Many physicians, Vu added, worried that prescribing too few pills could mean their patients feel more pain and consequently report lower satisfaction scores, which are used to judge a hospital's success.

Vu went on to say that not only have the guidelines been useful in preventing prescriptions of too many pills but that patients never felt their pain or concerns were ignored.

"It is important that this study be read, and people realize that changes are possible," said Sharfstein, adding that in fighting the opioid epidemic on several fronts, evidence-based recommendations could prove crucial.

Nithin Paul, M.D., M.P.H., is a family medicine and preventive medicine resident physician at Medstar and Johns Hopkins University writing for ABC News' Medical Unit.

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