Introduction:
Post-operative overprescribing of opioids contributes to the ongoing opioid epidemic by (i) leading to persistent use in a significant subset of patients and (ii) increasing the supply of opioids available for diversion and abuse. We evaluate the impact of statewide mandatory opioid stewardship initiatives (i.e., Prescription Drug Monitoring Plan (PDMP) verifications for prescriptions longer than 3 days duration and opioid specific continuing medical education for maintenance of licensure) implemented in 2017 on prescribing patterns following common urologic cancer procedures.
Methods:
We used Wisconsin Health Information Organization data, an all-payer claims database covering 75% of Wisconsin’s population, to identify patients undergoing prostatectomy, nephrectomy, transurethral resection of bladder tumors (TURBT), and cystectomy statewide between January 1, 2016 and December 31, 2017. We captured filled opioid prescriptions within 7 days of a discharge and identified dose (median morphine milligram equivalents (MME)), duration (median days) and opioid type for the initial prescription. We compared prescribing between July and December 2016 to the same months in 2017 to allow for an appropriate wash-in period and control for seasonality.
Results:
We identified 2,172 patients (561 prostatectomy, 466 nephrectomy, 1,086 TURBT and 59 cystectomy) undergoing our procedures of interest in 2016 and 1,977 patients (611 prostatectomy, 488 nephrectomy, 838 TURBT and 40 cystectomy) in 2017. Overall, 63.1% of patients filled an opioid prescription (62.8% prior and 65.2% post-policy, p=0.277). Fill rates were lowest following TURBT (47.6%) and similar for the three remaining procedures (70.7-78.3%). In 2016, prescriptions contained a median total MME of 150 (IQR=100-270), 4-day duration (IQR=3-6) with acetaminophen/hydrocodone being most commonly prescribed. In 2017, prescriptions contained a median total MME of 150 (IQR=100-225), 3-day duration (IQR=2-6) with acetaminophen/hydrocodone being the most commonly prescribed. Prescribing trends illustrated (Figure 1). When comparing the final 6 months of each year (n=966 July-December 2016; n=963 July-December 2017), no difference was noted in the median dose prescribed though variation in dose decreased (p<0.001) while prescription duration decreased from 4 to 3 days (p<0.001).
Conclusion:
In Wisconsin, mandatory statewide opioid stewardship policies mandating PDMP query for opioid prescriptions exceeding 3 days duration and opioid specific CME for maintenance of medical licensure was associated with a with a decrease in prescription duration without changes in the dose prescribed or patient fill rates following urologic cancer surgery. The median dose prescribed is equivalent to 30 tablets of acetaminophen 300mg/hydrocodone 5mg, a number substantially higher than reported patient use. Prescribers appear to have made the minimum necessary changes to achieve compliance with the policies instead of implementing meaningful changes in opioid prescribing following surgery. Direct surgeon engagement and surgeon-led local initiatives may be better positioned to achieve meaningful opioid stewardship following urologic cancer surgery.
Funding: N/A
Image(s) (click to enlarge):
STATEWIDE OPIOID STEWARDSHIP PROGRAMS NOT ASSOCIATED WITH CHANGES IN OPIOID PRESCRIBING FOLLOWING UROLOGIC CANCER SURGERY
Category
Health Services
Description
Poster #34
Wednesday, Dec 1
3:00 p.m. - 4:00 p.m.
Health Services/Penile Cancer
Presented By: Jeremy Goodman
Authors:
Tudor Borza
Manasa Venkatesh
Joanne Peters
Emily Serrell
Elise H. Lawson
Kyle A. Richards
E. Jason Abel
David F. Jarrard
Caprice C. Greenberg
Corrine I. Voils
Jessica R. Schumacher