Most Hand Surgery Patients Support Reduced Opioid Prescribing

According to a recent review, the average quantity of opioids prescribed for patients undergoing hand or upper extremity surgery is two to five times higher than the amount needed or consumed. This is of concern because the diversion of pills from valid prescriptions is a primary contributor to the epidemic of opioid-related emergency room visits, hospitalizations and overdoses.

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Still, surgeons may feel compelled to prescribe opioids to meet patient expectations, especially now that certain federal measures of health care quality depend on patient satisfaction ratings.

By surveying patients in the Hand and Upper Extremity Service at Massachusetts General Hospital, Neal Chen, MD, interim chief, Hand & Arm Center, Ana-Maria Vranceanu, PhD, director of the Integrated Brain Health Clinical and Research Program, and colleagues found that practice-wide policies designed to reduce the number of opioid pills available for misuse are apt to be well received. Also, nearly all patients expressed interest in having their surgeons educate them about opioids.

In The Journal of Hand Surgery, the researchers explain that they asked English-speaking adults to fill out a survey who had a regularly scheduled appointment between April and August 2016. Altogether, 118 consented to complete the survey (median age 49 years, 77% white, 64% with a traumatic injury, median education 16 years).

Most patients (72%) reported past use of opioids. Of the 41 who had used them for postsurgical pain, 76% said they had used opioids for 3 weeks or less, but 17% had used them for up to one year.

Beliefs About Prescription Opioids

Most patients (80%) indicated that opioids can be addictive, even when used for short periods of time, and that leftover pills should not be saved for future use. About three-quarters (78%) knew they could become addicted to opioids, and 90% said opioids could harm them. The average perceived effectiveness of opioids for pain control was seven on a scale of zero to 10.

Beliefs About Opioid Prescribing Practices

A majority of patients (71%) said physicians should prescribe as little opioids as needed, and 55% indicated that opioids should be prescribed only after trying nonopioid strategies. However, substantial percentages of people said opioids work well for long-term pain (28%), they could not become addicted to opioids (21%) or patients should receive as much opioid medication as they need (8%).

Most patients (65%) supported a practice-wide policy to decrease the amount of opioid medication prescribed. Past users of opioids were particularly likely to favor such a policy—73% vs. 50% of those who had never used opioids. Nearly all respondents (98%) said information about opioid prescriptions would be helpful or should be made available.

Perceived Importance of an Opioid Prescribing Policy

On a scale of zero to 10, patients rated how important they believed opioid prescribing policies would be for the Hand and Upper Extremity Service. The median score was 8.0 (interquartile range, 4). Higher education was the only factor uniquely associated with the greater perceived importance of such a policy.

That finding suggests, the researchers say, that surgeons should be aware of their patient's education level when assessing patient expectations about opioid medications.

They conclude that these data provide evidence that an opioid prescribing policy could be well received by patients, which should increase surgeons' confidence about reducing opioid prescribing and using nonopioid pain relief strategies.

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