Opioid Limits Don't Affect Surgery Patients

A recent study revealed that concerns that surgical patients would have a more difficult recovery if their doctors were required to adhere to a five-day restriction on opioid pain medicine prescriptions were unfounded.

Instead, the study found that once the state's top insurer imposed the limit, patient-reported pain levels and satisfaction were unchanged for Michigan individuals who had their appendix or gallbladder removed, a hernia fixed, a hysterectomy, or other common surgeries.

Simultaneously, the amount of opioid pain medicine patients covered by that insurer received fell shortly after the limit was implemented. Patients undergoing these procedures received no more than three fewer opioid-containing medications on average.

The study, which merges two statewide databases on patients covered by Blue Cross Blue Shield of Michigan (BCBSM), is the first large study to evaluate whether opioid prescribing limits change patient experience after surgery.

It's published in JAMA Health Forum by a team from Michigan Medicine, the University of Michigan's academic medical center.

The BCBSM limit of five days' supply, which went into effect in early 2018, is even stricter than the seven-days' supply limit put in place a few months later by the state of Michigan. Other major insurers and states have also implemented limits, most of which allow are seven-day limits.

Limits are designed to reduce the risk of long-term opioid use and opioid use disorder, as well as to reduce the risk of accidental overdose and the risk of unauthorized use of leftover pills.

"Opioid prescribing limits are now everywhere, so understanding their effects is crucial," said Kao-Ping Chua, M.D., Ph.D., the study's lead author. "We know these limits can reduce opioid prescribing, but it hasn't been clear until now whether they can do so without worsening patient experience."

He noted that even the 15% of patients who had been taking opioids for other reasons before having their operations didn't show an increase in pain or a decrease in satisfaction after the limit was put in place, even though opioid prescribing for these patients decreased. That decrease was actually contrary to the intent of the limit, which was only designed to reduce prescribing to patients who hadn't taken opioids recently.