Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Department of Surgery, University of Michigan, Ann Arbor, MI.
Surgery. 2023 Nov;174(5):1255-1262. doi: 10.1016/j.surg.2023.08.006. Epub 2023 Sep 13.
Excessive opioid prescribing has resulted in opioid diversion and misuse. In July 2018, Michigan's Public Act 251 established a state-wide policy limiting opioid prescriptions for acute pain to a 7-day supply. Traumatic injury increases the risk for new persistent opioid use, yet the impact of prescribing policy in trauma patients remains unknown. To determine the relationship between policy enactment and prescribing in trauma patients, we compared oral morphine equivalents prescribed at discharge before and after implementation of Public Act 251.
In this cross-sectional study, adult patients who received any oral opioids at discharge from a Level 1 trauma center between January 1, 2016, and June 30, 2021, were identified. The exposure was patients admitted starting July 1, 2018. Inpatient oral morphine equivalents per day 48 hours before discharge and discharge prescription oral morphine equivalents per day were calculated. Student's t test and an interrupted time series analysis were performed to compare mean oral morphine equivalents per day pre- and post-policy. Multivariable risk adjustment accounted for patient/injury factors and inpatient oral morphine equivalent use.
A total of 3,748 patients were included in the study (pre-policy n = 1,685; post-policy n = 2,063). Implementation of the prescribing policy was associated with a significant decrease in mean discharge oral morphine equivalents per day (34.8 ± 49.5 vs 16.7 ± 32.3, P < .001). After risk adjustment, post-policy discharge prescriptions differed by -19.2 oral morphine equivalents per day (95% CI -21.7 to -16.8, P < .001). The proportion of patients obtaining a refill prescription 30 days post-discharge did not increase after implementation (0.38 ± 0.48 vs 0.37 ± 0.48, P = .7).
Discharge prescription amounts for opioids in trauma patients decreased by approximately one-half after the implementation of opioid prescribing policies, and there was no compensatory increase in subsequent refill prescriptions. Future work is needed to evaluate the effect of these policies on the adequacy of pain management and functional recovery after injury.
过量开处阿片类药物导致了阿片类药物的转移和滥用。2018 年 7 月，密歇根州的第 251 号公法规定，将急性疼痛的阿片类药物处方限制为 7 天供应量。创伤会增加新的持续性阿片类药物使用的风险，但在创伤患者中，处方政策的影响尚不清楚。为了确定政策颁布与创伤患者处方之间的关系，我们比较了第 251 号公法实施前后出院时开处的口服吗啡等效物。
在这项横断面研究中，确定了 2016 年 1 月 1 日至 2021 年 6 月 30 日期间从一级创伤中心出院时接受任何口服阿片类药物的成年患者。暴露是指 2018 年 7 月 1 日开始入院的患者。计算患者出院前 48 小时的每日口服吗啡等效物和出院时的每日口服吗啡等效物处方。采用学生 t 检验和中断时间序列分析比较政策前后每日口服吗啡等效物的平均值。多变量风险调整考虑了患者/损伤因素和住院期间口服吗啡等效物的使用情况。
共有 3748 名患者纳入研究（政策前 n = 1685；政策后 n = 2063）。处方政策的实施与每日出院口服吗啡等效物的平均值显著下降相关（34.8 ± 49.5 与 16.7 ± 32.3，P <.001）。风险调整后，政策后出院处方差异为-19.2 口服吗啡当量/天（95%置信区间为-21.7 至-16.8，P <.001）。实施后 30 天获得再配药处方的患者比例没有增加（0.38 ± 0.48 与 0.37 ± 0.48，P =.7）。
创伤患者出院时阿片类药物的处方量在实施阿片类药物处方政策后减少了约一半，随后再配药处方没有补偿性增加。需要进一步研究这些政策对受伤后疼痛管理和功能恢复的充分性的影响。
