May 22, 2019
Extensive prescription and non-prescription opioid use is a major public health concern in the United States, which is accountable for more than 80% of the world’s opioid supply. Death due to opioid overdose rose by more than 300% between 2001 and 2016. Furthermore, a 2016 nationwide survey estimated that 2.1 million people had an opioid use disorder and 17,087 deaths could be attributed to commonly prescribed opioid medications in the U.S.
As our country battles opioid abuse, two recent studies by Midwest Orthopaedics at Rush (MOR) physicians show that physicians should look more carefully how they are prescribing opioids for patients with hip and knee pain – and for those undergoing a hip or knee replacement surgery.
One study conducted by Rush University Medical Center physicians and researchers was recently published in the Journal of Arthroplasty. The study team included MOR joint replacement surgeons Drs. Denis Nam, Tad Gerlinger, Craig Della Valle and Charles Hannon. The data showed that a surprising number of joint replacement patients had been taking opioids for hip and knee arthritis prior to surgery. And, many patients who were taking opioids within six months before surgery did not report their opioid use to their physicians. (This is also of interest because preoperative opioid use has been shown to lead to a higher risk of complications and inferior outcomes following lower extremity joint arthroplasty.)
This study also showed that in terms of opioid prescribers, primary care physicians wrote prescriptions for the majority of opioids for nonoperative treatment of arthritis, but a substantial amount came from pain management specialists and orthopedic surgeons.
The study’s authors believe physicians and patients should be better educated on the dangers of opioids for the treatment of hip and knee arthritis.
In a second study, this same group of MOR joint replacement physicians determined that many total joint patients are being prescribed more opioids after surgery than they need, leaving them with unused medication at home.
The study randomized patients to receive either 30 opioid pills or 90 opioid pills after hip and knee replacements. The study authors found that the median number of pills left over for patients who received 30 opioid pills was 15 (50%) while patients who received 90 opioid pills had a median 73 pills leftover (81%). They concluded that prescribing fewer pills resulted in equivalent pain and outcome scores and a reduction in the number of unused pills.
This is significant because it is estimated that up to 55% of prescription opioid abusers got access to them from a friend or relative who received the opioid prescription from a physician. Opioids can be an important component of postoperative pain relief, but improper use of these prescriptions places patients at risk of poor outcomes overdose or even death. And, with more than one million joint replacements performed annually in the U.S., discharge prescriptions of 30 opioid pills versus 90 could reduce the number of unused pills by more than 58 million annually.