Department of Epidemiology, Gillings School of Global Public Health.
Cecil G. Sheps Center for Health Services Research.
Med Care. 2022 Jan 1;60(1):75-82. doi: 10.1097/MLR.0000000000001663.
In response to concerns about opioid addiction following surgery, many states have implemented laws capping the days supplied for initial postoperative prescriptions. However, few studies have examined changes in the risk of prolonged opioid use associated with the initial amount prescribed.
The objective of this study was to estimate the risk of prolonged opioid use associated with the length of initial opioid prescribed and the potential impact of prescribing limits.
Using Medicare insurance claims (2007-2017), we identified opioid-naive adults undergoing surgery. Using G-computation methods with logistic regression models, we estimated the risk of prolonged opioid use (≥1 opioid prescription dispensed in 3 consecutive 30-d windows following surgery) associated with the varying initial number of days supplied. We then estimate the potential reduction in cases of prolonged opioid use associated with varying prescribing limits.
We identified 1,060,596 opioid-naive surgical patients. Among the 70.0% who received an opioid for postoperative pain, 1.9% had prolonged opioid use. The risk of prolonged use increased from 0.7% (1 d supply) to 4.4% (15+ d). We estimated that a prescribing limit of 4 days would be associated with a risk reduction of 4.84 (3.59, 6.09)/1000 patients and would be associated with 2255 cases of prolonged use potentially avoided. The commonly used day supply limit of 7 would be associated with a smaller reduction in risk [absolute risk difference=2.04 (-0.17, 4.25)/1000].
The risk of prolonged opioid use following surgery increased monotonically with increasing prescription duration. Common prescribing maximums based on days supplied may impact many patients but are associated with relatively low numbers of reduced cases of prolonged use. Any prescribing limits need to be weighed against the need for adequate pain management.
为应对手术后阿片类药物成瘾的担忧，许多州都颁布了法律，限制初始术后处方的供应天数。然而，很少有研究调查与初始处方量相关的延长阿片类药物使用风险的变化。
本研究旨在评估与初始阿片类药物处方长度相关的延长阿片类药物使用风险，并评估处方限制的潜在影响。
使用医疗保险索赔数据（2007-2017 年），我们确定了接受手术的阿片类药物初治成年人。使用 G 计算方法和逻辑回归模型，我们评估了与初始供应天数变化相关的延长阿片类药物使用（手术后连续 3 个 30 天窗口中至少开出 1 份阿片类药物处方）的风险。然后，我们估计不同处方限制与延长阿片类药物使用相关的潜在病例减少。
我们确定了 1060596 名阿片类药物初治手术患者。在接受术后疼痛阿片类药物治疗的 70.0%患者中，1.9%有延长阿片类药物使用。延长使用的风险从 0.7%（1 天供应）增加到 4.4%（15+天供应）。我们估计，处方限制为 4 天与风险降低 4.84（3.59，6.09）/1000 例相关，可避免 2255 例延长使用病例。常用的 7 天供应限制与风险降低幅度较小相关[绝对风险差异=2.04（-0.17，4.25）/1000]。
手术后延长阿片类药物使用的风险随着处方持续时间的增加而单调增加。基于天数的常见最大处方量可能会影响许多患者，但与减少延长使用病例的数量相对较少相关。任何处方限制都需要权衡对充分疼痛管理的需求。
