What is the Optimal Length of a Prescription for an Opioid Pain Medication After Surgery?


Media Advisory: To contact Louis L. Nguyen, M.D., M.B.A., M.P.H., email Elaine St. Peter at estpeter@bwh.harvard.edu.

Related material: The commentary, “Addressing Variability in Opioid Prescribing,” by Selwyn O. Rogers Jr., M.D., M.P.H., of University of Chicago Medicine, also is available at the For The Media website.

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JAMA Surgery

Findings from an analysis that included more than 200,000 patients who underwent common surgical procedures suggests that the optimal length of opioid pain prescriptions is four to nine days for general surgery procedures, four to 13 days for women’s health procedures, and six to15 days for musculoskeletal procedures, according to a study published by JAMA Surgery.

As rates of opioid prescribing have increased dramatically in recent years, the overprescription of pain medications has been implicated as a driver of the burgeoning opioid epidemic and the associated increases in overdose deaths in the United States. It is estimated that as many as 259 million opioid prescriptions were issued in 2012, four times the number prescribed in 1999. There is uncertainty regarding optimal prescribing practices for opioid pain medications, particularly in the setting of postoperative, outpatient pain management, where few guidelines exist.

Louis L. Nguyen, M.D., M.B.A., M.P.H., of Brigham and Women’s Hospital, Harvard Medical School, Boston, and colleagues used the Department of Defense Military Health System Data Repository to identify individuals who had undergone 1 of 8 common surgical procedures between January 2005 and September 2014 and had not previously used opioids.

Of the 215,140 individuals who underwent a procedure within the study time frame and received and filled at least one prescription for opioid pain medication within 14 days of their procedure, 19 percent received at least one refill prescription. The median prescription lengths were 4 days for appendectomy and gallbladder removal, 5 days for inguinal hernia repair, 4 days for hysterectomy, 5 days for mastectomy, 5 days for anterior cruciate ligament repair and rotator cuff repair, and 7 days for discectomy. The early nadir (the initial prescription duration associated with the lowest modeled risk of refill) in the probability of refill was at an initial prescription of nine days for general surgery procedures (probability of refill, 10.7 percent), 13 days for women’s health procedures (probability of refill, 16.8 percent), and 15 days for musculoskeletal procedures (probability of refill, 32.5 percent).

The study notes some limitations, including that it addresses only prescription opioid use within this population and cannot address opioid medications obtained through other means.

“An opioid prescription after surgery should balance adequate pain treatment with minimizing the duration of treatment and potential for medication complications including issues with dependence. Although 7-day limits on initial opioid pain medication prescriptions are likely adequate in many settings, and indeed also sufficient for many common general surgery and gynecologic procedures, in the postoperative setting, particularly after many orthopedic and neurosurgical procedures, a 7-day limit may be inappropriately restrictive,” the authors write.

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