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Effect of the Centers for Disease Control and Prevention opioid prescribing guidelines on postsurgical prescribing among veterans
Author(s) -
Karst Allison C.,
Hayes Brittany F.,
Burka Abigail T.,
Bean Jennifer R.,
Wallace Jessica L.
Publication year - 2019
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1055
Subject(s) - medicine , guideline , opioid , observational study , emergency medicine , morphine , chronic pain , retrospective cohort study , anesthesia , physical therapy , receptor , pathology
Background In 2016, the Centers for Disease Control and Prevention (CDC) published opioid prescribing guidelines. The literature review identified an association between opioids prescribed for acute pain and an increased risk for long‐term use. Guidelines recommend 3 days or less of therapy in most cases of acute pain. Prescriber education may be necessary. Objective To assess the impact of the CDC opioid prescribing guidelines and targeted prescriber education on postsurgical prescribing. Methods This study was a single‐center, retrospective, observational analysis of adult Veterans admitted for carotid endarterectomy or endovascular aneurysm repair during preguideline, postguideline, and posteducational intervention time frames. Exclusion criteria included chronic opioid use/abuse, hospitalization over 72 hours, and repeat operation. Pharmacists provided education on opioid prescribing during monthly surgery orientation. The primary end point was mean morphine equivalents (MMEs) prescribed at discharge. Secondary end points included distribution across morphine equivalents ranges, the days' supply of opioids prescribed, and percentage prescribed nonopioid therapy. Results MMEs decreased following guideline publication (295.82 MMEs preguidelines vs 160.68 MMEs postguidelines; P = 0.003). After prescriber education, a further absolute reduction in MMEs was seen, although not statistically significant (160.68 vs 139.29; P = 0.810). Days' supply prescribed decreased following guideline publication (8.17 days preguidelines vs 4.71 days postguidelines; P = 0.009); however, no statistical difference was observed posteducation (4.71 vs 3.29 days; P = 0.294). In addition, no difference was found in the percentage of nonopioid therapy prescribed postguidelines (70.83% vs 68.18%; P = 0.988) or posteducation (68.18% vs 64.29%; P = 1.00). Conclusions The 2016 CDC opioid prescribing guidelines likely had an impact on postsurgical opioid prescribing, evident by decreased MMEs and opioid days' supply following guideline publication. Although these end points did not reach statistical significance following prescriber education, the trends suggest clinical significance.