Studies Say Opioids Overprescribed After Surgery

By Pat Anson, Editor

Two new studies are adding evidence to claims that opioids are routinely over-prescribed for acute pain after dental and other types of low-risk surgery.

In a large study of over 2.7 million Medicaid patients published in JAMA, 42 percent filled a prescription for an opioid pain medication within 7 days of a tooth extraction. Opioids were dispensed even more often (61%) for teens aged 14 to 17.

"This common dental procedure may represent an important area of excessive opioid prescribing in the United States,” wrote lead author Brian Bateman, MD, of Brigham and Women’s Hospital in Boston.

"Although a limited supply of opioids may be required for some patients following tooth extraction, these data suggest that disproportionally large amounts of opioids are frequently prescribed given the expected intensity and duration of post-extraction pain.”

Three out of four opioid prescriptions were for a hydrocodone combination drug such as Vicodin. The study was conducted using data from 2000 to 2010, before hydrocodone was reclassified as a Schedule II controlled substance and became harder to obtain.   

Bateman and his colleagues said a combination of nonsteroidal medications and acetaminophen “may provide more effective analgesia” than opioids after dental surgery.

A similar study also published in JAMA looked at opioid prescription rates for about 14 million patients who had surgery for carpal tunnel syndrome, gall bladder removal, hernia repair or knee arthroscopy. Eighty percent of those patients filled a prescription for an opioid pain medication within 7 days of being discharged from the hospital.   

As Pain News Network has reported, efforts at targeting opioid abuse and addiction are increasingly focused not just on limiting opioid treatment for chronic pain, but acute pain as well.

Prescribing guidelines released Monday by the Centers for Disease Control and Prevention (CDC) state that acute pain “can often be managed without opioids.” When opioids are prescribed, the guidelines call on primary care physicians to prescribe “three days or less” for acute pain.

“Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than 7 days will rarely be needed,” the CDC guideline states.

The guidelines also caution doctors not to prescribe opioids “just in case” pain continues longer than expected.

Legislation recently introduced in Congress calls on the CDC to develop opioid prescribing guidelines for acute pain within two years.

Last month the American Pain Society released its own set of guidelines, which recommend that non-opioid medications such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin (Neurotin) and pregabalin (Lyrica) be used along with opioids for post-operative pain.