Restrictive Opioid Prescription Protocol Successfully Reduces Postoperative Opioid Use

The implementation of a restrictive opioid prescription protocol (ROPP) was feasible, reduced the number of opioids patients were prescribed, and did not impact the patient experience, according to a study presented during the 2021 ASCO Annual Meeting.

The study took place between February 2019 and July 2019 at a tertiary comprehensive cancer center for all patients undergoing a surgery that would ordinarily result in opioid prescriptions at discharge (n=2,015). The researchers compared these data to data on the same surgeries performed between August 2018 and January 2019 (n=2,051). Patients were not given opioids at discharge unless their procedure was maximally invasive or if they needed multiple doses of opioids while in the hospital. The patient experience was assessed using validated patient satisfaction surveys.

Following the implementation of a ROPP, the researchers reported that 45% less opioids were prescribed postoperatively, dropping from 323,674 morphine milligram equivalents (MME) pre-ROPP to 179,458 MME post-ROPP (P<0.001). Most services complied with ROPP in close to 100% of cases. Postoperative pain did not differ between the groups, and the ROPP group had less refill requests than the control group (17.9% vs. 20.9%; P=0.016). Surveys were completed by 338 control patients and 360 ROPP patients, and the groups did not report significant differences in postoperative pain control or the impact of pain on daily activities.

“Implementation of a ROPP by multiple surgical services at a tertiary cancer center was feasible and resulted in substantial decrease in the number of opioids prescribed while not compromising patient experience. Patients did not require more prescription refills despite being provided no opioids or a limited supply. This study provides evidence to support reducing the number of opioids routinely prescribed after surgery,” the researchers wrote in their conclusion.