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Michigan outperforms national trends in reducing opioid prescribing after surgery

By: Debbie Reinheimer

A spilled bottle of assorted pills

Opioid addiction is the top complication after surgery for patients who have never taken them before. Persistent opioid use happens when patients are prescribed opioids to help with post-surgical pain, but they continue to use the opioids well after post-surgical pain period.

The absence of established opioid prescribing guidelines for surgeons to follow contributed to the persistent use of opioids.

Those guidelines now exist thanks to a statewide effort by the Michigan Opioid Prescribing Engagement Network and the Michigan Surgical Quality Collaborative, both part of the Blue Cross Collaborative Quality Initiative program. And the levels of opioids prescribed after surgery are dropping in Michigan compared to other states.

“This work is critical as opioid addiction is the number one complication for previously opioid-naïve patients having elective surgery. By reducing the prescribing of opioids for post-surgical patients, it also reduces the number of unused opioids lying around in people’s medicine cabinets,” said Faris Ahmad, M.D., medical director, Blue Cross Blue Shield of Michigan.

To develop the prescribing guidelines, clinicians and researchers used data collected from several CQI clinical registries. The registries provide data on hundreds of thousands of procedures performed at surgical facilities across the state. Using the data, they were able to develop recommendations on how many opioids to prescribe following six common surgical procedures:

  • minimally invasive gallbladder removal
  • appendix removal
  • minor hernia repair
  • major hernia repair
  • removal of part of the colon (colectomy)
  • hysterectomy

According to a study published in Annals of Surgery, since the release of the OPEN prescribing guidelines, the rates of persistent opioid use after surgery have dropped in our state when compared to the rest of the nation.

Researchers analyzed prescribing patterns in the four years preceding the guidelines and for two years afterward.  In just under two years:

  • There was a 56% reduction in the amount of opioids patients received after having any of the six different common operations, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased. Both of those drops beat national trends for similar patients.
  • The average number of pills prescribed per case dropped by an additional 11 pills/case when compared to the reductions seen in other states.

“Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said Chad Brummett, M.D., co-director of Michigan OPEN. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”

The study focuses on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who had one of these procedures. Prescribing guidelines were implemented in 70 hospitals across Michigan.

Michigan OPEN is a partnership between Michigan Medicine, Blue Cross Blue Shield of Michigan and the Michigan Department of Health & Human Services.