Study investigates opioid use among orthopedic surgery patients

The use of opioid pain relievers is increasing at unprecedented rates. According to the U.S. Centers for Disease Control and Prevention, between 1999 and 2008, painkiller sales increased 300 percent. Up to 20 percent of prescription drug abusers receive their narcotics supply from a physician prescription, which accounts for 80 percent of all painkiller prescriptions.

A recent study, "Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Population," was published in the Journal of Bone and Joint Surgery and  presented at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons. Researchers sought to determine the effects of multiple postoperative narcotic providers on the number of narcotic prescriptions, duration of narcotics and morphine equivalent dose per day in the orthopedic trauma population.

To conduct the study, researchers used  the Tennessee Controlled Substance Monitoring Database and orthopedic electronic health records to identify all narcotic prescriptions filled three months before and six months after discharge from an orthopedic procedure for 151 adult, enrolled patients between January and December 2011. The patients were separated into two groups: those with a single narcotic provider who received one prescription from their treating orthopedic surgeon and patients with multiple narcotic providers, including their surgeon and additional physicians.

The study found that 20.8 percent of orthopedic surgery patients sought prescription pain medications from more than one physician, including their orthopedic surgeon. These patients used narcotics four times longer than those with a single provider. Specifically, the average time difference was 112 days for the former and 28 days for the latter.

Researchers also determined that patients with more than one prescription provider obtained a median of seven narcotic medications at once, compared to two prescriptions for single-provider patients. This resulted in higher doses as well – 43 milligrams compared to 26 milligrams. Another interesting statistic detailed by the study is that patients are 4.5 times more likely to seek an additional provider if they had a history of narcotic use before their orthopedic surgery and 3.2 times more probable to conduct that behavior if they have a high school education or less.

There were no differences between the single-provider and multiple-provider group in regard to age, sex, race, injury type, tobacco use, psychiatric history or comorbidities. However, the patients with multiple opioid prescriptions had an average age of 39.6 and 89 percent were white, while 63 percent were male.

"Our study highlights the importance of counseling patients in the postoperative period, and that it is important to work together to establish reasonable expectations for pain control as part of treatment plan discussions and follow-up visits," said Brent J. Morris, M.D., orthopedic surgeon at Vanderbilt Orthopaedic Institute of Vanderbilt University Medical Center and lead author of the study. "A standardized pain protocol for specific operative and nonoperative treatment plans with an opioid taper may also be helpful."

The study's researchers suggested that prescription drug monitoring databases and orthopedic EHR software that support medication reconciliation can effectively reduce prescription drug abuse if orthopedic surgeons consult them prior to surgery.