How Mayo Clinic's prescribing guidelines are cutting opioid prescriptions by half

After analyzing opioid prescribing practices following surgery and improving prescribing guidelines, researchers at the Mayo Clinic Department of Orthopedic Surgery in Rochester, Minn., saw a 48 percent decrease in opioids prescribed for hip and knee replacement surgery, according to a study published in Clinical Orthopaedics and Related Research.

"These findings show that simply creating and adhering to procedure-specific opioid prescribing guidelines based on scientific research can yield significant results," said lead author Cody Wyles, MD.

 The research team analyzed Mayo Clinc opioid prescriptions for 25 common surgeries and uncovered numerous areas for improvement. To address these areas, the researchers developed opioid prescribing guidelines for the common surgeries, which the Department of Orthopedic Surgery initially implemented.

The study examined opioid prescriptions and refill rates for knee and hip replacement patients at Mayo Clinic's Rochester campus who had not received a prescription in the 90 days preceding surgery. The researchers compared 751 patients from August-December 2017 — five months after the guidelines were implemented — to 1,822  patients from 2016 who met the same criteria.

The study revealed the median prescription dropped 48 percent, from roughly 95 pills of five-milligram oxycodone before the changes were implemented to approximately 50 pills. Overall, the middle 50 percent range of prescriptions dropped from roughly 70-115 pills to 45-50 pills. The researchers did not find a statistically significant change in refill rates.

"The fact that refill rates remained the same is significant because it means we can adequately control most of our patients' pain with these lower doses," said senior author Tad Mabry, MD. "We want to make a reduction in an informed way so we don't under-treat patients' pain."

The researchers continue to follow adherence to the guidelines, noting compliance steadily rose during the five-month study. The team will continue to evaluate and refine the guidelines to address patient needs, Dr. Mabry said.

More articles on opioids: 
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Study: Synthetic opioids linked to more overdose deaths than prescription killers

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