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Prolonged Opioid Use After Orthopaedic Surgery Linked to Quantity Prescribed Upon Discharge

Article

Originally published in American Academy of Orthopaedic Surgeons

In This Article

  • Results showed that only opioid quantity was predictive of prolonged use, regardless of which type of opioid was prescribed
  • Prolonged use was defined as opioid use continuing past 90 days after injury
  • Researchers emphasized the importance of calculating morphine milligram equivalents when converting opioid doses

Prolonged opioid use after orthopedic surgery is related to the quantity of the opioid prescribed to a patient upon discharge, according to new research led by Marilyn Heng, MD, MPH, FRCSC, orthopaedic trauma surgeon in the Department of Orthopaedics at Massachusetts General Hospital.

The findings of the study, which were published in the Journal of the American Academy of Orthopaedic Surgeons, demonstrated that the type of opioid prescribed to a patient is not predictive of prolonged use when equivalence calculations are performed.

In their research, Dr. Heng and colleagues studied over 17,000 adult, opiate-naïve patients treated for a surgical musculoskeletal injury. Patients included in the findings of the study had no prior history of opioid abuse and hadn't taken opioids in the six months leading up to their injury.

Initial multivariable analysis—not considering initial opioid quantity—showed that patients discharged on hydromorphone, morphine or multiple different opioid types were more likely to continue using opioids 90 days after their injuries compared to patients who were prescribed hydrocodone.

However, when researchers adjusted for initial opioid quantity by calculating the amount of morphine milligram equivalents (MMEs) in prescribed doses, the results showed that only opioid quantity was predictive of prolonged use, regardless of which type of opioid was prescribed.

While orthopaedic surgeons are the third-highest prescribers of opioids among US physicians, Dr. Heng said that providers tend to make opioid prescription decisions based on the number of tablets rather than calculating the MMEs in that dose.

Researchers concluded that these findings support the importance of using MMEs to determine the most appropriate discharge prescription for patients following orthopaedic surgery.

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