Attitudes and self-reported practices of orthopedic providers regarding prescription opioid use

Deepa Kattail, MD, MHS; Aaron Hsu, MHS; Myron Yaster, MD; Paul T. Vozzo, BA; Shuna Gao, BA; John M. Thompson, MD; Debra L. Roter, DrPH; Dawn Laporte, MD; R. Frank Henn 3rd, MD; John E. Fiadjoe, MD; Constance L. Monitto, MD

doi:10.5055/jom.2019.0505

Authors

Deepa Kattail, MD, MHS
Aaron Hsu, MHS
Myron Yaster, MD
Paul T. Vozzo, BA
Shuna Gao, BA
John M. Thompson, MD
Debra L. Roter, DrPH
Dawn Laporte, MD
R. Frank Henn 3rd, MD
John E. Fiadjoe, MD
Constance L. Monitto, MD

DOI:

https://doi.org/10.5055/jom.2019.0505

Keywords:

acute postoperative pain, opioid epidemic, risk mitigation

Abstract

Objective: Orthopedic surgeons are the third-highest opioid prescribers in the United States. Their prescribing practices can significantly affect the quantity of unconsumed opioids available to fuel the current opioid epidemic. The aim of this study was to identify prescribing patterns and knowledge gaps among orthopedic providers for targeted future interventions and investigation.

Design: An online survey describing six common orthopedic surgical scenarios was distributed electronically to determine opioid type and quantity prescribed at discharge, medication disposal instructions, and the use of prescription drug monitoring programs (PDMPs) in the prescription writing process.

Setting: Tertiary care academic hospitals.

Participants: Orthopedic physicians and mid-level providers practicing at Johns Hopkins Medical Institutions and University of Maryland Medical System. Of 179 providers contacted, 127 (71 percent) completed the survey.

Main outcome measures: Quantity of opioid prescribed, utilization of PDMPs, and provision of opioid disposal instructions.

Results: While statistically significant associations were identified between quantity of opioid prescribed and surgical procedure, for five of six scenarios 95 percent of respondents recommended prescribing >55 oxycodone 5 mg pill equivalents (PEs) at discharge. An inverse correlation between years of clinical practice and mean number of PEs prescribed was observed. Fewer than 40 percent of respondents modified prescribing when presented with clinically relevant changes in scenario (history of depression or drug abuse). Over 60 percent of respondents do not use PDMPs, and 79 percent do not provide opioid disposal instructions.

Conclusions: Our findings support a need for targeted education to mitigate the role of orthopedic postoperative prescribing practices on the current opioid abuse epidemic.

Author Biographies

Deepa Kattail, MD, MHS

Assistant Professor, Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada

Aaron Hsu, MHS

Research Assistant, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Myron Yaster, MD

Professor, Department of Anesthesiology, University of Colorado-Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado

Paul T. Vozzo, BA

Research Assistant, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Shuna Gao, BA

Research Assistant, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

John M. Thompson, MD

Fellow, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland

Debra L. Roter, DrPH

Professor, Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Dawn Laporte, MD

Professor, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland

R. Frank Henn 3rd, MD

Associate Professor, Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, Maryland

John E. Fiadjoe, MD

Assistant Professor, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Constance L. Monitto, MD

Assistant Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

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