The Road to Optimal Opioid Prescription Length

The Centers for Disease Control and Prevention (CDC) estimates that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year. Most of that burden is related to workplace costs, such as lost productivity, prolonged time on disability, and increased work disability claim costs.

To help combat this crisis, organizations such as the Official Disability Institute (ODG) and The American College of Occupational and Environmental Medicine (ACOEM) have released guidelines for prescribers in the appropriate use of opioids for treating pain specific to workplace injuries.

In a study published in a recent edition of the Journal of Occupational and Environmental Medicine, researchers at the ReedGroup and Kaiser Permanente retroactively applied ACOEM’s April 2017 guidelines to 7,840 patients who underwent carpal tunnel release (CTR) surgery from 2007 to 2014. Of the 70 percent of cases prescribed an opioid, 29 percent were contrary to the guidelines, which recommend no more than a five-day supply of short-acting opioids for acute postoperative pain for new users. Patients given greater dosages averaged disability durations 1.9 days longer and medical costs $422 higher than their ACOEM-compliant counterparts.

While these cases were not exclusively workers’ compensation related, given the volume of injured workers who require CTR surgery annually, it’s easy to see how following the guidelines could substantially benefit payers and patients. The study estimates if 29 percent of the 577,000 CTR procedures performed annually were prescribed an opioid according to ACOEM’s guidelines, the potential medical cost savings is $71 million per year with a reduction in disability durations by 124,000 days. Incredible.

Clinicians at the Center for Surgery and Public Health at Brigham and Women’s Hospital took guideline research a step further by analyzing more than 200,000 postoperative opioid prescribing patterns to define the ideal prescription length by procedure type. Their research, published by JAMA Surgery, determined the optimal length of opiate prescription was four to nine days for general surgery procedures, four to 13 days for women’s health procedures, and six to 15 days for musculoskeletal procedures.

While it’s too soon to know the time and monetary impact these guidelines could yield if implemented, it’s heartening to see that the risk of prescription opioid misuse is being considered when looking to alleviate temporary acute pain. We must all be mindful of what is in the patient’s long-term best interests and limiting opioid prescription duration is a critical step in that process.