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- Title
Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation.
- Authors
Xie, Yanjun; Joseph, Andrew W.; Rudy, Shannon F.; Elner, Victor M.; Demirci, Hakan; Kim, Denise S.; Nelson, Christine C.; Joseph, Shannon S.
- Abstract
<bold>Importance: </bold>Understanding whether statewide legislation, such as the Michigan Opioid Laws, is associated with reduction in postoperative opioid prescriptions is informative in guiding future legislation.<bold>Objective: </bold>To identify changes in opioid prescribing patterns for oculoplastic and orbital procedures associated with the enactment of the Michigan Opioid Laws in 2017 and 2018.<bold>Design, Setting, and Participants: </bold>This cross-sectional study included 3781 patients who underwent any of 10 common oculoplastic and orbital procedures between June 1, 2016, and November 30, 2019, at a tertiary care institution.<bold>Exposures: </bold>From 2017 to 2018, Michigan enacted a series of laws to address the state's worsening opioid epidemic. Two major components of this legislation enacted on June 1, 2018, required prescribers to review a report of patients' opioid use history and obtain signed consent after educating patients on the use and disposal of opioids prior to prescribing.<bold>Main Outcomes and Measures: </bold>Demographic information, type of surgery, type and amount of opioid prescriptions, and morphine milligram equivalent (MME) were analyzed. MME was calculated as the product of dose, quantity, and opioid-specific conversion factor for each prescription. Linear interpolation spline regression was used to evaluate the association of prescription MME with time.<bold>Results: </bold>Of 3781 patients, 1614 (42.7%) were male. The mean (SD) age at the time of surgery was 63.3 (16.6) years. Of 2026 patients undergoing surgery before June 1, 2018, 1782 (88.0%) were prescribed postoperative opioids; of 1755 patients undergoing surgery after June 1, 2018, 878 (50.0%) were prescribed postoperative opioids (P < .001). There was no difference in age, sex, race/ethnicity, surgery type, or opioids prescribed between these 2 cohorts. Linear interpolation spline regression showed a decrease of 26.025 MMEs (equivalent to a 36.2% reduction of mean MME) between June 1, 2017, and September 30, 2018 (β, -1.735; 95% CI, -0.088 to -0.024; P < .001), stabilizing at a persistently reduced rate of MME prescribed through the end of the study period (October 1, 2018, to November 30, 2019; β, -0.005; 95% CI, -0.039 to 0.016; P = .42). Changes in MME in the 12 months before or 12 months after the period of legislation enactment were not identified.<bold>Conclusions and Relevance: </bold>In this cross-sectional study, reduction in opioid prescriptions for oculoplastic and orbital procedures was observed during the enactment period of the Michigan Opioid Laws and appeared to be sustained through the end of the study period. Similar statewide or national legislations aimed at increasing prescriber awareness and patient education on opioid use may help curtail the prescription opioid epidemic.
- Subjects
MICHIGAN; THERAPEUTIC use of narcotics; DRUG laws; EYE-socket surgery; NARCOTICS; ANALGESICS; TIME; CROSS-sectional method; PLASTIC surgery; STATE governments; RETROSPECTIVE studies; TREATMENT effectiveness; POLICY sciences; DRUG utilization; MEDICAL prescriptions; POSTOPERATIVE pain
- Publication
JAMA Ophthalmology, 2021, Vol 139, Issue 2, p157
- ISSN
2168-6165
- Publication type
journal article
- DOI
10.1001/jamaophthalmol.2020.5446