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Home E-Weekly July 18, 2017

Post-op Opioids Overprescribed at Mayo Clinic

Published: July 17, 2017

SUPPLY AND DEMAND Standardized prescribing guidelines can leave patients in pain or at risk of addiction.

Physicians at the Mayo Clinic in Rochester, Minn., have called themselves out for overusing opioids to manage post-op pain and say a lack of evidence-based prescribing guidelines is to blame.

Mayo researchers reviewed about 5,750 opioid prescriptions written across the health system to patients who did not take the painkillers at least 90 days before surgery. The findings, published in the Annals of Surgery, showed 4 out of 5 prescriptions written at the health system exceeded the amount currently outlined in Minnesota state prescribing guidelines. The median prescription was equivalent to 50 pills of 5 mg oxycodone — or nearly twice the amount of the state guideline maximum dose. Surgeons at the Minnesota campus prescribed a median of 40 pills, while their colleagues at the health system's campuses in Florida and Arizona prescribed the equivalent of 50 and 60 pills, respectively.

The researchers concede there is room for improvement in opioid prescribing within the health system, but they also point out there are no evidence-based guidelines that focus on the prescribing opioids after surgery. "That's the fundamental issue," says study coauthor Robert Cima, MD, chair of surgical quality at the Mayo Clinic. "And because pain is very subjective, it makes it challenging."

Issues also arise when standardized prescribing guidelines aren't appropriate for surgeries associated with varying levels of post-op pain. For example, the statewide guidelines in Minnesota might not be appropriate for all orthopedic procedures, some of which can cause a significant amount of post-op discomfort. For that reason, the Mayo Clinic's department of orthopedic surgery is developing a tiered approach for prescribing opioids based on the surgical procedure that's performed.

Dr. Cima also points to the importance of partnering with patients to set realistic expectations about the pain they'll experience after surgery. "We actively support patients, but they also need to be educated that some discomfort is part of the process," he says. "We want patients to be comfortable enough to function, but taking away all the pain isn't an appropriate part of recovery."

Daniel Cook

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