At the Kellogg Eye Center, researchers sought to learn how opioid prescribing could be improved to avoid misuse while adequately helping patients manage pain during recovery.
They developed a plan: Doctors in the cornea clinic would give patients fewer pills after surgery – the time when many people are first introduced to opioid medications. They would also talk to patients about the proper use of opioids and the associated risks.
The seemingly small interventions showed the number of tablets could be decreased without compromising pain control, according to findings presented at the 2019 annual meeting of the Association for Research in Vision and Ophthalmology.
“Two recent policy changes – one by our institution, and one by our state – combined to create this new opportunity to learn about post-operative opioid consumption,” says study author Maria Woodward, MD, a cornea specialist at the Kellogg Eye Center and health services researcher at the U-M Institute for Healthcare Policy and Innovation. “First the cornea division at Kellogg changed policy, decreasing the number of opioid tablets we prescribe. Second, the state of Michigan instituted a mandatory prescription monitoring program.”
The study team identified 82 patients who underwent cornea surgery and surveyed them post-surgery about how many pills they actually used, what pain they experienced after surgery, and what they did with any leftover pills.
Before the policy change, the average prescription for cornea surgery was 18.8 pills. When researchers interviewed patients, the amount of opioid medication they’d actually taken after the operation was 8.
The rest was often still sitting in their medicine cabinets, or carried around with them.
After the policy change, the average prescription for cornea surgery dropped to 6.6 pills and patients reported using just four.
Within the group receiving the lower pill count, 70 percent of patients reported that the prescription was adequate to control pain and 22 percent reported receiving more pills than they needed. Only 7 percent felt they received less medication than needed for pain control.
“We were very encouraged to see that even a dramatic reduction in the number of opioid pills prescribed had no negative impact on pain control,” says Woodward, who is also an assistant professor of Ophthalmology and Visual Sciences at the University of Michigan.
The study reveals there’s more work to be done to keep leftover surgery opioids out of harm’s way. In the study, 85 percent of patients did not discard of the pills as recommended by taking them to a health center or police station for disposal.
“This study shows we’re making progress in the battle against opioid misuse,” Woodward says. “But we can do more to make sure that everyone knows how to prescribe them, use them and dispose of them safely.”