Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA.
Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Subst Abus. 2022;43(1):932-936. doi: 10.1080/08897077.2022.2056934.
Since 2017, states, insurers, and pharmacies have placed blanket limits on the duration and quantity of opioid prescriptions. In many states, overlapping duration and daily dose limits yield maximum prescription limits of 150-350 morphine milligram equivalents (MMEs). There is limited knowledge of how these restrictions compare with actual patient opioid consumption; while changes in prescription patterns and opioid misuse rates have been studied, these are, at best, weak proxies for actual pain control consumption. We sought to determine how patients undergoing surgery would be affected by opioid prescribing restrictions using actual patient opioid consumption data. We constructed a prospective database of post-discharge opioid consumption: patients undergoing surgery at one institution were called after discharge to collect opioid consumption data. Patients whose opioid consumption exceeded 150 and 350 MME were identified. Two thousand nine hundred and seventy-one patients undergoing 54 common surgical procedures were included in our study. Twenty-one percent of patients consumed more than the 150 MME limit. Only 7% of patients consumed above the 350 MME limit. Typical (non-outlier) opioid consumption, defined as less than the 75th percentile of consumption for any given procedure, exceeded the 150 MME and 350 MME limits for 41 and 7% of procedures, respectively. Orthopedic, spinal/neurosurgical, and complex abdominal procedures most commonly exceeded these limits. While most patients undergoing surgery are unaffected by recent blanket prescribing limits, those undergoing a specific subset of procedures are likely to require more opioids than the restrictions permit; providers should be aware that these patients may require a refill to adequately control post-surgical pain. Real consumption data should be used to guide these restrictions and inform future interventions so the risk of worsened pain control (and its troublesome effects on opioid misuse) is minimized. Procedure-specific prescribing limits may be one approach to prevent misuse, while also optimizing post-operative pain control.
自 2017 年以来，各州、保险公司和药店对阿片类药物处方的持续时间和数量设置了全面限制。在许多州，重叠的持续时间和每日剂量限制导致最大处方限制为 150-350 吗啡毫克当量 (MME)。关于这些限制与实际患者阿片类药物消费的比较，人们知之甚少；虽然已经研究了处方模式和阿片类药物滥用率的变化，但这些充其量只是实际疼痛控制消费的薄弱替代指标。我们试图确定使用实际患者阿片类药物消费数据，手术患者会受到阿片类药物处方限制的影响。我们构建了一个术后阿片类药物消费的前瞻性数据库：在一家机构接受手术后的患者在出院后被呼叫以收集阿片类药物消费数据。确定阿片类药物消费超过 150 和 350 MME 的患者。我们的研究纳入了 2971 名接受 54 种常见手术的患者。21%的患者消费超过 150 MME 限制。只有 7%的患者消费超过 350 MME 限制。典型（非异常值）阿片类药物消费，定义为任何特定手术消费的第 75 百分位以下，分别超过 150 MME 和 350 MME 限制的 41%和 7%的手术。骨科、脊柱/神经外科和复杂腹部手术最常超过这些限制。虽然大多数接受手术的患者不受最近全面处方限制的影响，但某些特定手术的患者可能需要超过限制允许的阿片类药物；提供者应注意，这些患者可能需要续药才能充分控制术后疼痛。应使用实际消费数据来指导这些限制，并为未来的干预措施提供信息，以尽量减少疼痛控制恶化（及其对阿片类药物滥用的麻烦影响）的风险。特定手术的处方限制可能是防止滥用的一种方法，同时也能优化术后疼痛控制。
