Fewer opioids over more time linked to lower costs, better outcomes

March 17, 2017 – The findings may point the way toward better strategies for reducing opioid abuse.

Providing fewer total opioids over a longer period of time is associated with lower overall costs and utilization for hip surgery patients, according to a new study by DCRI researchers.

With opioid overdoses and abuse a subject of growing concern for public health agencies, the Centers for Disease Control issued a series of guidelines in 2016 intended to improve communication between clinicians and patients about the risks and benefits of opioid drug therapy. While these guidelines included recommendations for acute, general surgery opioid management, there has been little research into management strategies for intermediate- to long-term post-surgical musculoskeletal pain.

In an observational cohort study, the DCRI’s Chad Cook, PhD (pictured), and his colleagues sought to analyze post-operative opioid prescription strategies and measure direct and indirect health care utilization and costs in individuals undergoing non-arthroplasty orthopedic hip surgery.

The study appears in the current issue of the journal Substance Abuse Treatment, Prevention, and Policy.

Using data from the Military Health System Data Repository (MDR), which serves as the centralized data repository for all Defense Health Agency corporate health care data, the researchers identified 1,219 patients who received hip surgery between 2003 and 2015.The dataset included information on opioid management for 12 months before and 24 months after surgery.

Using cluster analysis, Cook and his study team then identified two distinct post-operative opioid prescription subgroups: patients who received a high total number of opioids over a short period of time (850 patients), and those who received fewer total opioids over a longer period of time (369 patients).  The researchers then used linear mixed effects modeling to examine opioid prescription pattern subgroups and identify subgroup differences in health care utilization and costs.

The overall trend was that the subgroup prescribed more opioids over a shorter duration had more pre-operative comorbidities, opioid prescriptions, and total days of opioid pain medications. That subgroup was also younger and had higher proportions of heavy preoperative health care utilization. Noting that this finding ran counter to their hypothesis, the researchers posited four possibilities for this outcome: that the findings are reflective of pre-operative comorbid conditions; that the subgroup receiving more opioids over a shorter amount of time was associated with the preoperative opioid use patterns of its patients; that the subgroup receiving fewer opioids over a longer amount of time benefited more from opioids by receiving adequate pain management; and that higher costs and utilization are associated with increased incidences of side effects in the subgroup receiving more opioids over a longer amount of time.

These findings, Cook said, illustrate the need for randomized trials to better understand the effectiveness of opioid prescription patterns on reducing side effects and minimizing the chances of opioid abuse.

“We need to start looking at patterns of treatment,” he said. “We couldn’t find anything in the literature about other musculoskeletal conditions or postsurgical conditions. This topic is essentially unstudied.”

In addition to Cook, the study’s authors included Daniel I. Rhon, Brian D. Lewis, and Steven Z. George.