Tougher Rules on Opioids After Surgery Doesn't Mean More Pain for Patients

WEDNESDAY, Oct. 30, 2019 (HealthDay News) -- Patients' pain management wasn't compromised after Vermont implemented new rules that aimed to reduce the use of opioid painkillers after surgery, a new study shows.

The new rules, introduced in July 2017, require doctors to explain to patients the risks and benefits of opioids (such as OxyContin), outline non-opioid painkiller alternatives, and educate them on the safe disposal of unused opioids.

Before a new prescription is written for more than 10 opioid pills, doctors must check a patient's pain medication history in the state prescribing database, and patients must sign an informed consent.

In this study, University of Vermont Medical Center researchers examined opioid prescribing for 15 common operations across four surgical specialties (vascular, general, orthopedic and urologic surgery). The investigators looked at prescribing patterns for the 12 months before the new rules took effect (365 procedures) and the 17 months afterward (768 procedures).

The median morphine milligram equivalents (MME) -- a measure of cumulative potency of pain medicines prescribed -- fell by 33%, the findings showed.

The median MME prescribed before and after July 2017 were 96 and 64, respectively. The median MME used after surgery was zero after the regulations, compared with 16 MME before the regulations, the study authors said.

The percentage of patients who did not receive any opioids after surgery more than doubled, from 12.7% before the new rules to 26% after the new rules.

The study was to be presented Tuesday at the American College of Surgeons annual meeting, in San Francisco. Such research should be considered preliminary until published in a peer-reviewed journal.

"The clear trend is that physicians are prescribing less, patients are using less, and there is no appreciable change in patient-reported pain control or satisfaction after implementation of these regulations," said researcher Dr. Mayo Fujii. She is a clinical instructor in surgery at the University of Vermont Larner College of Medicine.

"That patients are using less may reflect the impact of patient education efforts to establish expectations of postoperative pain and use non-opioid pain management strategies, as well as public awareness of the opioid epidemic," she said in an American College of Surgeons news release.

Poor pain control is one possible concern when reducing opioid use after surgery, but the study found that wasn't an issue.

"Despite the decrease in amount of medication prescribed, there did not appear to be any significant change in refill rates or patient-reported satisfaction with pain control," Fujii said.

More information

The American Academy of Family Physicians has more on pain control after surgery.