1. Nalley, Catlin

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Researchers found that a restrictive prescribing practice allows for a substantial reduction in the quantity of opioids prescribed, while patients remained highly satisfied with their pain management, according to findings released by the Society of Gynecologic Oncology (Abstract 48).

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"Over the last 20 years, deaths from opioid overdose have increased six-fold. Alabama, the state where we practice, has one of the highest opioid prescribing rates in the nation," noted study author Teresa Boitano, MD, from The University of Alabama at Birmingham. "In general, we know that physicians overprescribe pain medications, and this can lead to misuse and abuse.


"Given this, we created a restrictive opioid prescribing algorithm (ROPA) in order to decrease the number of unused opioids in the community," she explained. "We performed this study to ensure our patients understood the ROPA protocol and that their pain was adequately controlled with less opioids."


Methods, Results

This retrospective cohort study, which included gynecologic oncology patients undergoing any surgical procedure from October 2018 to August 2019, sought to evaluate their satisfaction with the ROPA. A control group without restrictive prescribing practices was identified from October 2016 to September 2017. The researchers educated patients preoperatively about pain management goals, the ROPA, and disposal of leftover opioids.


"Standardized prescriptions were written on discharge based on surgical complexity (four-tiered system) and 24-hour postoperative opioid use," the study authors outlined. "During the first 6 months of the study, patients were asked to complete a survey at their postoperative visit evaluating patient satisfaction, number of leftover pills, and disposal methods."


The study enrolled 2,549 patients with 1,321 in the control group and 1,369 in the ROPA group. Between the two cohorts, patient demographics, including age, BMI, and surgical procedures, were similar.


The average number of pills prescribed at discharge was significantly lower in the ROPA group (30.5 pills vs. 11.3 pills). Of the 694 patients who were asked to complete the survey, 406 (58.5%) did so.


"The majority (95.7%) of patients were very satisfied or somewhat satisfied with their pain management care," Boitano reported. "Eighty percent of patients filled their opioid prescription; one-third of patients with leftover opioids disposed of them; and there was no increase in ED visits or opioid refills.


"The average number of pills prescribed went from 30 to 11 pills per patient," she added. "This restrictive prescribing practice removed an estimated 20,242 pills from the community over the period of 1 year."


Among patients who disposed of their leftover pills, the most common method was toilet flushing while the least common was at a disposal center, according to the study authors, who noted that further research is underway to address disposal methods for leftover medication.


There were some surprising findings, Boitano noted. For instance, 20 percent of patients never even filled their opioid prescription, 50 percent of patients had leftover pills, and there was no increase in number of opioid refill requests.


What Happens Next?

Given the ongoing opioid crisis, these findings offer valuable insight into ways to address this issue.


"We removed an estimated 20,242 pills from the community, which decreases the risk for misuse and abuse," Boitano told Oncology Times. "It helps physicians become more cognizant of appropriate opioid prescribing practices.


"[This approach] is broadly applicable to surgical specialties, and our goal is to implement similar practices across our whole hospital system," she continued. "Additionally, about 50 percent of patients had leftover pills; however, only about one-third of these patients tried to dispose of them. The most common methods were flushing down the toilet or throwing away in the trash mixed with coffee grounds. We will investigate methods to increase disposal in environmentally friendly ways."


Boitano noted that this approach is used in acute surgical patients. "Cancer patients with chronic pain will continue to require individualized pain prescribing practices," she concluded.


Catlin Nalley is a contributing writer.


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