Effect of the Centers for Disease Control and Prevention opioid prescribing guidelines on postsurgical prescribing among veterans

BackgroundIn 2016, the Centers for Disease Control and Prevention (CDC) published opioid prescribing guidelines. The literature review identified an association between opioids prescribed for acute pain and an increased risk for long-term use. Guidelines recommend 3 days or less of therapy in most cases of acute pain. Prescriber education may be necessary. ObjectiveTo assess the impact of the CDC opioid prescribing guidelines and targeted prescriber education on postsurgical prescribing. MethodsThis study was a single-center, retrospective, observational analysis of adult Veterans admitted for carotid endarterectomy or endovascular aneurysm repair during preguideline, postguideline, and posteducational intervention time frames. Exclusion criteria included chronic opioid use/abuse, hospitalization over 72 hours, and repeat operation. Pharmacists provided education on opioid prescribing during monthly surgery orientation. The primary end point was mean morphine equivalents (MMEs) prescribed at discharge. Secondary end points included distribution across morphine equivalents ranges, the days' supply of opioids prescribed, and percentage prescribed nonopioid therapy. ResultsMMEs decreased following guideline publication (295.82 MMEs preguidelines vs 160.68 MMEs postguidelines; P = 0.003). After prescriber education, a further absolute reduction in MMEs was seen, although not statistically significant (160.68 vs 139.29; P = 0.810). Days' supply prescribed decreased following guideline publication (8.17 days preguidelines vs 4.71 days postguidelines; P = 0.009); however, no statistical difference was observed posteducation (4.71 vs 3.29 days; P = 0.294). In addition, no difference was found in the percentage of nonopioid therapy prescribed postguidelines (70.83% vs 68.18%; P = 0.988) or posteducation (68.18% vs 64.29%; P = 1.00). ConclusionsThe 2016 CDC opioid prescribing guidelines likely had an impact on postsurgical opioid prescribing, evident by decreased MMEs and opioid days' supply following guideline publication. Although these end points did not reach statistical significance following prescriber education, the trends suggest clinical significance.