Patients need only half of the opioids they're prescribed after surgery and take only a fraction of the opioids they receive, according to new research published in the Annals of Surgery, which suggests overprescribing the painkillers increases the risk of abuse.
Researchers at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., assessed the post-op opioid prescription fill and refill rates of 642 patients who underwent outpatient partial mastectomy, partial mastectomy with sentinel lymph node biopsy, laparoscopic cholecystectomy, laparoscopic inguinal hernia repair or open inguinal hernia repair.
The researchers also conducted phone interviews to determine how many pills the patients actually took. Overall, only 28% of the prescribed pills were consumed. The researchers say only 43% of the actual number of prescribed pills was needed to provide patients with the amount of pills they actually took. The findings also indicate a wide variation in the number of pills that were prescribed: For example, the number of opioids received by patients who underwent lap choles ranged from 10 to 100 pills.
Richard Barth Jr., MD, chief of general surgery at Dartmouth-Hitchcock and one of the study's authors, says the variation in the number of prescribed opioids is based on physicians' perceptions of how many opioids patients will need to control post-op pain, a lack of knowledge about how many pills patients actually take and differing guidelines regarding the number of pills that should be prescribed after particular types of cases.
"Providers also want to make sure the pain that patients experience is minimized, so they prescribe enough to satisfy the patient who requires the most opioids," says Dr. Barth. "It's also likely that the desire to avoid the inconvenience — both to the patient and the provider — of a return trip to the clinic to obtain a prescription refill drives over-prescription."
The study says setting patients' expectations about the number of pills they'll need to mange post-op pain and using non-opioid analgesics such as ibuprofen and acetaminophen would decrease the amount of opioids prescribed and, therefore, potentially abused.
"Opioid overdose is now the leading cause of injury-related death in the United States, having surpassed motor vehicle accidents for the first time," says Dr. Barth. "We can do better than this to keep our patients comfortable after surgery and safe from the dangers of misuse."