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Opioid prescribing trends: Changes after focused hospital resident education and after subsequent adoption of new state regulations

Victoria Simmons, MD, Sejul Chaudhary, MD, Karen Hagglund, MS, R. David Hayward, PhD, Elango Edhayan, MD


Objective: We examined changes in opioid prescriptions after outpatient laparoscopic cholecystectomy (LC) before and after (1) an educational intervention for surgical residents and (2) subsequent changes in state regulations for handling these prescriptions.

Design: A single-institution retrospective review evaluated opioids prescribed on discharge in morphine milligram equivalents (MMEs) over three periods: Period 1, prior to educational intervention (October 1, 2017 to January 31, 2018); Period 2, after intervention and before regulation changes occurred (February 1, 2018 to May 31, 2018); and Period 3, after changes in regulations went into effect (June 1, 2018 to September 30, 2018).

Setting: A large urban teaching hospital in Detroit, Michigan.

Patients: All adults receiving outpatient LC during one of the study periods. Patients with a history of regular opioid use prior to surgery were excluded. There were 49 patients in Period 1, 57 in Period 2, and 51 in Period 3.

Interventions: All general surgery residents participated in an education session focusing on problems related to opioid addiction, prescribing trends, and multimodal pain control options in February 2018.

Main outcome measure: Mean MME per patient was compared between time periods.

Results: Average MME was reduced from 87.11 in Period 1 to 65.96 in Period 2 to 51.80 in Period 3. Analysis of variance showed MME differed significantly among the periods. Scheffe post hoc t-tests showed MME prescribed during Periods 2 and 3 were each significantly lower than Period 1, whereas Periods 2 and 3 did not differ significantly.

Conclusions: MME prescribed after outpatient LC significantly decreased after the educational intervention and remained low after state mandate went into effect.


opioids, prescribing practices, educational interventions, regulation

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