Mayo Clinic Develops Guidelines Against Opioid Abuse

(CN) — Nearly one-third of U.S. patients who undergo one of 25 common surgeries do not take the opioid painkillers they were prescribed, the Mayo Clinic reported on Thursday.

The results, presented Thursday at the American Surgical Association annual meeting and published in the journal Annals of Surgery, came as the number of opioid prescriptions filled in the United States continues to drop: by 29 percent since peaking in 2011, according to separate findings.

As staggering U.S. opioid addiction rates alarm health care workers, patients and policymakers, the findings from the study demonstrate that awareness is growing, and that doctors can take steps to stem prescriptions of the painkillers.

To examine recent trends in opioid prescribing and use, doctors at the Mayo Clinic surveyed 1,907 patients who underwent at least one of 25 common surgeries at three academic medical centers.

The authors found that at discharge 92 percent of respondents received an opioid prescription, 63 percent of which went unused. Nearly 30 percent indicated they were prescribed too many opioids, while 8 percent said they were prescribed too few. Ninety percent were satisfied with their pain control.

The median amount of opioids consumed per patient was equivalent to six pills of 5-milligram oxycodone.

“This research provides a road map for physicians and surgical departments. It shows there are certain surgeries and types of patients who are likely receiving significantly more opioids than needed,” said senior author Elizabeth Habermann, scientific director of surgical outcomes research at the Mayo Clinic.

The results may help in developing guidelines and optimizing the opioid prescriptions patients receive after surgery. In light of the findings, as well as the team’s past research, the Mayo Clinic has introduced evidence-based opioid prescribing guidelines specific to surgical areas, starting with the Department of Orthopedic Surgery.

These guidelines have produced a considerable reduction in opioid prescriptions in the department: The median amount prescribed for total knee and total hip surgeries plunged by 50 percent.

“These new Mayo Clinic guidelines allow prescribers to tailor their prescribing to address the needs of patients who need very little or no opioids, along with those who need more pain control, while still optimizing and reducing prescribing across the board,” said Cornelius Thiels, a general surgery resident in the Mayo Clinic School of Graduate Medical Education.

Patient factors associated with a lower use of opioids include older age, a lower pain score at discharge and no history of anxiety.

Factors that could indicate the need for additional opioids include younger age, a higher pain score at discharge and a history of anxiety.

“Opioid prescribing guidelines should be based on evidence, considering patient factors and the type of procedure, but also allowing for prescriber discretion,” Habermann said. “This research and numerous other opioid prescribing projects at Mayo Clinic are about identifying the best approach for each individual patient, whether that’s increasing, decreasing or maintaining prescription levels.”

The team said that the one-size-fits-all limits for opioid prescribing that are championed by many prescription drug plans and lawmakers to manage acute pain may not be in patients’ best interests.

“They are not patient-centered and may inadvertently encourage both over- and underprescribing,” Thiels said. “This highlights to us the importance of developing procedure-specific, evidence-based discharge opioid prescribing guidelines.”

The authors said that when patients do not properly dispose of their extra opioids, it could contribute to abuse. This risk can be limited by reducing prescriptions, when appropriate, and educating people on proper disposal methods.

While U.S. opioid prescription rates have decreased in recent years, the number of opioid overdose deaths increased by 500 percent from 1999 to 2016, according to the Centers for Disease Control and Prevention.

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