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Study: Patients use a fraction of opioids prescribed after surgery

Text-based patient monitoring finds that surgical patients often use fewer opioids to manage pain than they were prescribed. Photo by Cindy Shebley/Flickr
Text-based patient monitoring finds that surgical patients often use fewer opioids to manage pain than they were prescribed. Photo by Cindy Shebley/Flickr

March 25 (UPI) -- About 60% of people undergoing orthopedic and urologic surgery use less than half of the post-op opioid medications prescribed for pain, a study published Thursday by JAMA Network Open found.

On average, a patient undergoing orthopedic surgery, such as hip or knee replacement, took six of the 20 tablets prescribed, the data showed.

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Those who had urologic surgeries such as prostate and bladder procedures, on average, used one of seven tablets prescribed.

Only 21% of orthopedic surgery patients and 11% of urology patients required a refill for pain medication a month after their procedures.

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"We found that more than 60% of the opioid tablets prescribed went unused," study co-author Dr. Anish Agarwal said in a press release.

"We can begin to use these data ... to look at trends in patient-reported use and tailor future prescribing to meet the anticipated pain for the majority of patients," said Agarwal, an assistant professor of emergency medicine at the University of Pennsylvania in Philadelphia.

This would have the added benefit of reducing the number of opioid tablets in circulation. Misuse of prescription painkillers has helped fuel the ongoing epidemic of drug abuse nationwide, the researchers said.

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For this study, Agarwal and his colleagues used an automated text-messaging system to regularly check in with patients on their pain and opioid use following surgery.

This type of approach is relatively new, but gaining in popularity, as it can help physicians "right-size" prescriptions, the researchers said.

Over a span of several months in 2019, they enrolled 919 patients who had undergone common surgeries such as knee replacement and vasectomy.

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Participants rated their pain on a scale of zero to 10 and were asked if they felt able to manage their pain on the fourth day following their procedure.

Subsequent texts went out on 7, 14 and 21 days after surgery to measure change in responses over time.

Each text also inquired about opioid tablet use, which was matched to the patients' initial prescriptions.

Over the course of the study, patients' text responses showed that average pain scores fell and their ability to manage pain climbed.

This seemed to be accomplished with fewer opioid pills than prescribed, with most of the pills taken within the first few days following a procedure, the researchers said.

By day seven, most patients had stopped taking them.

Sixty-four percent of patients didn't use half of their prescription and the majority did not require refills.

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The researchers are in the process of rolling out the automated text-messaging platform to additional surgical groups within the Penn Medicine health system, they said.

"The potential to translate these findings to tailor post-operative prescribing to patient needs and change national practice is high," study co-author Dr. M. Kit Delgado said in a statement.

"[Our study] shows that patients only take a fraction of the amounts that we know are prescribed on average across the country," said Delgado, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania.

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