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    Comprehensive Ophthalmology, Oculoplastics/Orbit

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    Review of: Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation

    Xie Y, Joseph A, Rudy S, et al. JAMA Ophthalmology, December 2020

    This cross-sectional study assessed changes in opioid prescribing patterns for oculoplastic and orbital procedures after enactment of the Michigan Opioid Laws in 2017 and 2018.

    Study design

    Researchers examined 3,781 patients who underwent any of 10 common oculoplastic and orbital procedures between June 2016 and November 2019. Beginning June 2018, Michigan required prescribers to review the patient's opioid use history and obtain the patient’s signed consent after being educated on the use and disposal of opioids prior to prescribing. Demographic information and amount of opioid prescriptions (using morphine milligram equivalent [MME]) were analyzed.

    Outcomes

    Prior to June 2018, 88% of patients were prescribed postoperative opioids compared with 50% after the law took effect (P<0.001). There was a decrease in 26 MMEs —a 36.2% reduction—between June 2017 and September 2018, which persisted until the end of the study.

    Limitations

    As this study was limited to a single tertiary care academic institution, the results may not translate to community-based healthcare. It would be interesting to query the surgeons as to why they decided against or reduced prescription: Was this due to opioid overuse awareness or was this just due to the fact that it was now more difficult to prescribe medication? Were there patients who would have benefited from a prescription who did not get one due to the new time-consuming process necessary for a prescription?

    Clinical significance

    Overdoses due to the opioid epidemic have resulted in the enactment of number state laws to curtail these incidents. As people are often first exposed to opioids through prescriptions, oculoplastic surgeons should not prescribe postoperative opioids without careful consideration first. This study demonstrates the efficacy of state mandates to help decrease opioid prescribing patterns. However, it is unclear if the decrease observed in this study is merely due to the fact that the laws are making it difficult to prescribe opioids, rather than an enhanced awareness of opioid overuse by the prescriber.