LSU Health New Orleans study finds dramatic drop in opioid rx after state legislation enacted

New Orleans, LA – A study led by Dr. Peter Krause, Professor of Orthopaedic Surgery at LSU Health New Orleans School of Medicine, reports a nearly 70% drop in morphine milligram equivalent (MME) per discharge opioid prescriptions for patients who had common lower extremity surgical procedures after state laws to reduce opioid abuse were enacted in Louisiana in 2017. Patients receiving at least one new opioid prescription after their discharge also sharply declined from 2013 to 2018. Results are published ahead of print online in the Journal of the American Academy of Orthopaedic Surgeons, available here.

            The authors write, “Given the high levels of opioid prescribing observed in 2013 to 2017 in this study, it is apparent that the Controlled Substance Act passed in 2014 and implementation of the state Prescription Drug Monitoring Program in 2008 were largely unsuccessful in curtailing opioid prescribing. In fact, the Controlled Substance Act may have led to an inadvertent increase in the quantity of opioid pills prescribed at discharge by making it more difficult for physicians to order refills of opioid prescriptions.”        

They note that Louisiana had the fifth-highest opioid prescribing rate in the country in 2017. That was also the year that Louisiana passed laws (House Bill 192 by Rep. Helena Moreno and Senate Bill 55 by Sen. Fred Mills) limiting first-time opioid prescriptions for acute pain to a 7-day supply, requiring prescribers to check the state’s Prescription Drug Monitoring Program (PDMP) database before prescribing opioids to reduce “doctor shopping” and mandating continuing education for prescribers of controlled substances.

            “This study showed that enactment of statewide laws in Louisiana aimed at reducing opioid prescribing for acute pain resulted in a notable decline in both discharge opioid prescribing and new opioid prescriptions for patients who were particularly vulnerable to chronic opioid use and who underwent common outpatient lower extremity surgeries,” notes Dr. Krause.

            The researchers reviewed the electronic medical records of 655 patients who underwent five common lower extremities surgical procedures -- surgery to repair broken ankles, soft tissue surgical procedures like tendon repair, arthroscopic anterior cruciate ligament (ACL) reconstruction, arthroscopic meniscus repair of the knee, or surgical implant removal -- from January 1, 2013, to December 31, 2018. Opioid prescription data were collected.

The researchers report, “For all procedures combined, there were significant differences in the mean number of pills, MME per pill, and MME per prescription over time. The mean MME per prescription ranged from a high of 524 in 2014 to a low of 160 in 2018, representing a 69.5% reduction. A significant decrease in the mean MME per discharge prescription was observed in 2018 versus all previous years. The proportion of patients who received at least one new opioid prescription after their discharge prescription declined from a high of 50% in 2013 to a low of 19.3% in 2018, with a significant effect over time.”

            The authors conclude, “Public health interventions and enactment of data-driven opioid prescribing laws are vital to reducing opioid abuse and dependence and circulation of excess prescription opioids in the community. Additional research is needed to determine optimal

thresholds for initial opioid prescribing for orthopaedic surgeries that may require varying levels of analgesia.”

            The LSU Health New Orleans research team included Amy B. Bronstone, PhD; Claudia Leonardi, PhD; Tara Kubilay, BA; and Gregory M. Tortorich, MD. Co-authors also included Daniel S. Plessl, MD, from Harvard Medical School and Peter J. Morreale, MD, from the Washington University St. Louis School of Medicine.

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LSU Health New Orleans (LSU Health Sciences Center New Orleans) educates Louisiana's health care professionals. The state's flagship health sciences university, LSU Health New Orleans includes a School of Medicine with branch campuses in Baton Rouge and Lafayette, the state's only School of Dentistry, Louisiana's only public School of Public Health, and Schools of Allied Health Professions, Nursing, and Graduate Studies. LSU Health New Orleans faculty take care of patients in public and private hospitals and clinics throughout the region. In the vanguard of biosciences research in a number of areas in a worldwide arena, the LSU Health New Orleans research enterprise generates jobs and enormous economic impact. LSU Health New Orleans faculty have made lifesaving discoveries and continue to work to prevent, advance treatment, or cure disease. To learn more, visit http://www.lsuhsc.edu, http://www.twitter.com/LSUHealthNO, or http://www.facebook.com/LSUHSC.      

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