Reduced Opioid Prescriptions Have Little Impact on Pain Control


Maria Woodward, MD, MSc, discusses the impact of reducing opioid prescriptions following corneal surgery.

A recent study from the Kellogg Eye Center at the University of Michigan is shining new light on how patients react and adapt to limited opioid prescriptions after surgery.

Led by Maria Woodward, MD, MSDc, results revealed most patients did not use all opioids prescribed to them—even when given a reduced dose—but also revealed most patients fail to properly dispose of unused pills.

In an effort to examine the effectiveness of opioid prescribing policies, investigators from the Kellogg Eye Center conducted a prospective cohort study comprised of patients who had recently underwent corneal surgery before and after updates to the opioid prescribing guideline. A cohort of 112 patients were identified and 82 consented to participate in the analysis—of these, 38 participated in the first cohort and 44 in the second.

Investigators included corneal procedures such as penetrating keratoplasty, collagen cross-linking, photorefractive keratectomy, and superficial keratectomy. All patients included were contacted within a month following surgery and surveyed on remaining opioid prescription.

Of the 38 patients in the first cohort, 89% (38) received an opioid prescription compared with 70% (31) in the second cohort (P=0.05). Among patients who received a prescription, on average the first cohort (18.8; SD 4.2) received more than double the amount of pills than the second cohort (6.6; SD 3.1) (difference 12.2(95% CI, 10.4-14.0) P<0.001).

In regard to use, patients in the first cohort used a mean of 8.3 tablets compared to 4.0 tablets in the second cohort (difference, 4.3 (95% CI, 1.4-7.2) P=0.005). Additionally, patients in the first cohort had more unused opioids than the second cohort (mean, 10.3 versus 2.9; difference, 7.5 (95% CI, 4.7-10.2) P<0.001).

Earlier this year at ARVO 2019, Woodward sat down with MD Magazine® to discuss what a greater understanding of how patients use opioids following surgery can provide clinicians.

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