A statewide effort in Michigan to treat the pain of surgery patients without increasing their risk of long-term dependence on opioids has led to dramatic improvement, according to a study by Michigan Medicine
The Michigan effort used prescribing guidelines based on real-world evidence about how many opioid doses surgery patients actually need to ease their pain, compared with what they were prescribed.
In less than two years, the effort led to a 56 percent reduction in the amount of opioids patients received after having six different common operations, and a 26 percent drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased.
Both of those drops beat national trends for similar patients, according to the new study published in Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center.
Michigan patients having certain operations – for instance, to remove part of their colon – saw the biggest drops over the study period in how many opioids they received after their operations. They also had the biggest drop in risk of developing persistent opioid use, which the researchers define as filling opioid prescriptions for months or years after surgery, when their initial surgery-related prescription was intended for short-term use.
Researchers stressed that the guidelines don’t leave patients in pain. In fact, past research showed that surgery patients receiving smaller opioid prescriptions had similar pain outcomes and were just as satisfied with their pain care.
Ryan Howard, M.D., M.S., the resident in the U-M Department of Surgery who led the analysis, explained the significance in a statement. “Tens of millions of people have operations in the U.S. every year, and most of them go home with a prescription for an opioid painkiller. Although they are meant for short-term use during recovery from surgery, unfortunately, some patients keep filling opioid prescriptions for months or years after surgery, which raises their risk of opioid use disorder, overdose, and death,” he said. “Reducing those trends is a key part of addressing our national opioid problems.”
The achievement was driven by the Opioid Prescribing Engagement Network (OPEN) and the Michigan Surgical Quality Collaborative (MSQC) – both based at U-M – and by surgical team leaders at 70 hospitals across the state that take part in MSQC and have implemented OPEN guidelines.
“Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said senior author Chad Brummett, M.D., co-director of OPEN and director of pain research at Michigan Medicine’s Department of Anesthesiology, in a statement. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”
The team also showed that declines in Michigan – where these guidelines were implemented – outpaced the nation, and other Midwest states, by comparing records from tens of thousands of patients who had the six types of operations in Michigan and those who had them in other states.
Helping patients get leftover opioids out of their homes and disposed of safely is another key goal of the opioid prescribing engagement network. They offer several free programs to Michigan organizations including free medication disposal pouches, permanent disposal boxes and medication take back event planning materials.
Both MSQC and OPEN receive funding from Blue Cross Blue Shield of Michigan. The opioid prescribing engagement network also has received funding from the Michigan Department of Health and Human Services and National Institutes of Health, as well as support from the U-M Institute for Healthcare Policy and Innovation.