Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery
Autor: | James M. Dupree, Jay Lee, Jennifer F. Waljee, Michael J. Englesbe, Caitlin Khalsa, Rena Steiger, Joe Habbouche, Chad M. Brummett |
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Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
business.industry Retrospective cohort study Surgery Interrupted Time Series Analysis 03 medical and health sciences Schedule (workplace) 0302 clinical medicine Opioid Hydrocodone 030220 oncology & carcinogenesis medicine 030212 general & internal medicine Medical prescription Young adult Elective Surgical Procedure business medicine.drug |
Zdroj: | JAMA Surgery. 153:1111 |
ISSN: | 2168-6254 |
Popis: | Importance In 2014, the US Drug Enforcement Administration moved hydrocodone-containing analgesics from schedule III to the more restrictive schedule II to limit prescribing and decrease nonmedical opioid use. The association of this policy change with postoperative prescribing is not well understood. Objective To examine the hypothesis that the amount of opioids prescribed following surgery is associated with the rescheduling of hydrocodone. Design, Setting, and Participants An interrupted time series analysis of outpatient opioid prescriptions was conducted to examine the trends in the amount of postoperative opioids filled before and after the schedule change. Opioid prescriptions filled between January 2012 and October 2015 were analyzed using insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan. A total of 21 955 adult inpatients 18 to 64 years of age who underwent 1 of 19 common elective surgical procedures and filled an opioid prescription within 14 days of discharge to home were eligible for inclusion. Main Outcomes and Measures The primary outcome was the trends in the mean amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of October 6, 2014, compared using interrupted time series and multivariable regression analyses. Secondary outcomes included the total amount of opioids filled and the refill rate for the 30-day postoperative period. Subgroup analyses were performed by hydrocodone prescriptions, nonhydrocodone prescriptions, surgical procedure, and prior opioid use. Results Data from 21 955 patients undergoing surgical procedures across 75 hospitals and 5120 prescribers were analyzed. Cohorts before and after the schedule change were equivalent with respect to sex (10 197 of 15 791 [64.6%] vs 3966 of 6169 [64.3%] female;P = .69) and mean (SE) age (47.9 [11.2] vs 47.7 [11.3] years;P = .19). After the schedule change, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs (β = 35.1 [13.2];P Conclusions and Relevance Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors. |
Databáze: | OpenAIRE |
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