New postoperative guideline may significantly cut opioid prescriptions

A new prescribing guideline after surgery can reduce opioid pill prescriptions by almost half, according to a study published in the Journal of the American College of Surgeons.

Researchers examined 333 hospital inpatients who were discharged to home after bariatric procedures; operations on the stomach, liver and pancreas; ventral hernia repair; and colon procedures. They followed up with the patients after discharge using questionnaires and phone surveys. Ninety percent of the discharged patients completed the follow-up process. None of the participants were chronic opioid users.

Researchers found that while 85 percent of patients were prescribed an opioid, only 38 percent of prescribed opioid pills were taken. According to the study, over half the patients were taking opioids for non-pain-related reasons, "such as to sleep better, or because they felt they should take all the pills the physician prescribed and other various and sundry reasons," said lead study author Richard J. Barth Jr., MD, of Dartmouth Hitchcock Medical Center in Lebanon, N.H.

The researchers developed a guideline that recommends the following schedule for post-discharge opioid prescription:

•    No pills for patients who did not take opioids the day before they left the hospital
•    15 pills for those who took one-to-three pills the day before
•    30 pills for those who took four or more pills on their last day in the hospital

The guideline could reduce the number of opioid pills prescribed after surgery almost 40 percent, the researchers estimated.

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