The same prescribing practices that stirred the country’s opioid crisis continues, according to a recent study published in BMJ Open. The study, which analyzed a database of national insurance claims, concluded that 36 percent of knee surgery patients received opioid prescriptions stronger than the amount recommended by the Centers for Disease Control and Prevention (CDC).
Although opioid prescription rates range widely from one state to the next, the average dose following the type of knee surgery considered in this study connects with a higher incidence of opioid overdose deaths, researchers found.
The study revealed a wide variation among states regarding the rate at which opioids were prescribed for patients who never had before taken opioids. The national rate reached more than 70 percent, with a range across states of between 40 to 85.
Lead study author Benjamin Ukert, MD attributed some of the variation among states to differences in state policies, including mandates to check prescription drug monitoring program data. Ukert suggested such policies tend to influence opioid prescribing rates. “However, most state policies are aimed at patients with a history of opioid use, and our study focuses on patients who do not have that history. Thus, practice and organizational styles may be more important factors for this population.”
Of particular concern, the research indicated an alarmingly high strength for a representative prescription—a strength tantamount to 50 milligrams of morphine each day. The CDC identifies this level of strength as the threshold for the heightened risk of death by opioid overdose.
“We’ve also seen that the average number of pills prescribed was extremely high for outpatient procedures of this type, particularly for patients who had not been taking opioids prior to surgery,” said the study’s senior author M. Kit Delgado, MD, an assistant professor of Emergency Medicine and Epidemiology in the Perelman School of Medicine at the University of Pennsylvania.
What makes this information so troubling is the propensity for worsening an already dire opioid epidemic across the nation. Patients who have never before taken opioids are being prescribed high dosages of the drugs, despite the fact that research has shown this combination leads to long-term use of opioids. It also translates to a greater number of leftover pills, which in turn translates to a greater risk of overdose among patients’ family members, according to Medical Express, a publication of the Perelman School of Medicine at the University of Pennsylvania.