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  • Impact of State Legislation on Opioid Prescribing

    By Jean Shaw
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, February 2021

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    Do statewide laws designed to curb opioid prescribing have an impact on the number of such prescriptions for surgical procedures? Xie et al. set out to assess this issue in the wake of the en­actment of the Michigan Opioid Laws in 2017 and 2018. They found a signifi­cant reduction in postoperative opioid prescriptions for selected oculoplastic and orbital procedures after the new laws were in place.

    For this cross-sectional study, the authors reviewed clinical data on 3,781 patients who underwent one of 10 common oculoplastic and orbital procedures at the University of Michi­gan between June 1, 2016, and Nov. 30, 2019. They also collected data on all outpatient opioid prescriptions ordered for each surgery and calculated mor­phine milligram equivalents (MMEs) to characterize the amount of opioids prescribed prior to, on the day of, and immediately after surgery.

    Acetaminophen-hydrocodone was the most commonly prescribed opioid (87% of prescriptions); others included tramadol and oxycodone.

    The patients’ mean age was 63.3 years, and 1,614 (42.7%) were male. Of 2,026 patients who underwent surgery before June 1, 2018, 1,782 (88%) were prescribed post-op opioids. Of the 1,755 who underwent surgery after June 1, 2018, 878 (50%) were prescribed opioids postoperatively. Similarly, the MMEs given in the pre­scriptions declined by 36.2% during the same time frame.

    The mean prescription amount in the full study period was equivalent to 80.1 MMEs. With regard to specific surgical procedures, the mean amounts of opioids prescribed were highest for three orbital procedures—periorbital approach to orbital floor fracture repair (117.1 MMEs), enucleation with orbital implant (108.1 MMEs), and orbitoto­my for decompression with bone flap (91.5 MMEs). The lowest mean MME amounts were observed with entropion repair (61.9 MMEs) and blepharoptosis repair (64.7 MMEs). No prescribers provided opioid refills for any prescrip­tions.

    The authors noted several limitations of the study, including a lack of data on patient-initiated refill requests and the inability to track whether patients obtained prescriptions from other providers outside the university system. Nonetheless, they said, the findings provide support for similar legislative efforts to curb the opioid crisis. (Also see related commentary by Anton M. Kolomeyer, MD, PhD, and Bryan L. VanderBeek, MD, MPH, MSCE, in the same issue.)

    The original article can be found here.