OBJECTIVE
The increasing number of overdoses and deaths caused by opioids spotlights a complex public health crisis faced by the American society. Hence, concerns surrounding the dependence and abuse of narcotics have led to new laws and regulations of opioid prescriptions. In 2017, New York state implemented a Mandatory Prescriber Education for prescribers licensed to issue controlled substances, including opioids.
This study tracked opioid prescriptions of orthopedic surgeons following total joint arthroplasty in both 2014 and 2017 to evaluate trends in opioid prescriptions following changes in legislation and an increased public awareness of the opioid crisis. This study aims to identify the recent progress made by orthopedic surgeons in combating the public health crisis of opioid addiction in an urban patient population that is at a greater risk of developing opioid dependence and abuse.
METHODS
Retrospective analysis was conducted on 35 randomized patients from 2014 and 35 randomized patients from 2017 who underwent total joint arthroplasty (TJA) at BronxCare Health System. The data collected included the total number of opioid prescriptions and the total morphine equivalent for each patient. These variables were evaluated for both six months prior to and six months post-surgery. Opioid prescription information was derived from computerized pharmacy records, pre-operative risk assessments, and operative reports.
Medical records and operative reports were also reviewed to identify the patients’ age, sex and history of pre-operative narcotic use. Additionally, twelve orthopedic surgeons at the BronxCare Health System Department of Orthopaedics were surveyed in 2018 regarding their protocol for prescribing opioids in both 2014 and 2017, corresponding to the years in which patient data was collected. Orthopedic surgeons were also asked to identify factors that resulted in a shift in opioid issuance, if applicable.
RESULTS
Between 2014 and 2017, a significant decrease in the total morphine equivalent dosage (MED) prescribed was observed (p = 0.009, N = 70), going from 3437.57 to 960.07 morphine equivalents. A significant decrease in the number of months a TJA patient stays on opioids post-op was also observed (p = 0.015), from 1.89 months in 2014 to 0.93 months in 2017. Pre-op opioid users were suggestively prescribed more opioids (p = 0.008) for longer (p = 0.001), with a mean MED of 5665 compared to a mean of 999 for non-pre-op opioid users, and a mean period of 2.96 months compared to 0.87 months for non-pre-op opioid users. This study had 18 such patients with additional conditions that were treated by prescription opioids within 6 months prior to surgery. Among the variables analyzed, prior substance abuse (PSA) was a significant indicator: patients with PSA were prescribed more opioids (p = 0.027) for longer (p = 0.026), with a total MED of 7662 compared to 1288 for patients without substance abuse history, and a mean period of 3.04 months compared to 1.13 months. Among the 70 patients, 10 reported polysubstance abuse prior to their TJA. Obesity, hypertension, and gender all proved to be insignificant determinants of opioid prescription amount (p = 0.0155, 0.487, 0.408) or length of usage (p = 0.480, 0.408, 0.320). CONCLUSION This study revealed a decrease in orthopedic surgeon issuance of opioids for patients who underwent total joint arthroplasty in 2017, as compared to patients who underwent the same procedure in 2014. As the patient population of BronxCare Health System exists within the urban setting of the South Bronx, New York is at a greater risk of developing opioid dependence, this study provides data to support the positive effects of increased public awareness, as well as increased legislature and regulations, on decreasing opioid dependence and abuse.
Chloe Zana 1, Lauren McAllister 2, Kylen Soriano 3, Morteza Meftah 4 , Sheila Moran 1, Ira Kirschenbaum 2 1 Brown University, 2 Orthopaedic Surgery, BronxCare Health System, 3 University of California at San Francisco, 4 Orthopaedic Surgery, NYU/Langone