Opioid Prescription After Carpal Tunnel Release Is Declining Independent of State Laws

Daniel J. Cunningham, MD, MHSc; Eliana B. Saltzman, MD; Daniel J. Lorenzana, MD; Christopher S. Klifto, MD; Marc J. Richard, MD; Tyler S. Pidgeon, MD

Disclosures

J Am Acad Orthop Surg. 2021;29(11):486-497. 

In This Article

Results

Median patient age was 60 to 64 years (Table 1). Men comprised 36.8% of the cohort. 27.5% of patients were obese. 28.6% of patients demonstrated preoperative opioid filling (6 month preoperative to 1 month preoperative). The median CCI was 0. The distribution of patients across the 2010 to 2018 time frame was even with consideration of fewer patients who were able to meet 1-year active insurance status at the end of the data set's available time frame (2018) and fewer patients available for analysis in 2010.

64.8% of patients filled at least one opioid prescription in the 90-day perioperative time period (Table 2). 23.7% of patients filled two or more prescriptions during this same time frame. Among patients who filled an opioid prescription within the 90-day perioperative time period, the mean first opioid prescription was 33 oxycodone 5-mg pills and mean cumulative filling was 72 oxycodone 5-mg pills. Additional time frames are included for comparison in the Supplemental Digital Content, Appendix Tables 2 and 3, http://links.lww.com/JAAOS/A587.

As shown in Table 3 and Figures 1 and 2, the volume of opioid in the initial prescription filling has decreased from approximately 34 oxycodone 5-mg pills in 2010 to 27 oxycodone 5-mg pills in 2018 and the cumulative 90-day prescribing has decreased from approximately 96 oxycodone 5-mg pills in 2010 to 56 oxycodone 5-mg pills in 2018. For initial prescription filling volume, all years exhibited statistically significant decreases compared with 2010 with exception of 2011. For cumulative 90-day opioid prescription filling volume, all years exhibited statistically significant decreases compared with 2010. Rates of refill (2 or more opioid prescriptions filled), increased to 30% in 2013 from 23% in 2010 but decreased to 20.1% in 2018.

Figure 1.

Figure demonstrating the initial prescription oxycodone 5-mg equivalent volume for patients filling at least one opioid prescription within the 30PRE-90POST cohort. Error bars represent standard deviation. All years had significantly decreased opioid prescribing compared with 2010 with exception of 2011.

Figure 2.

Figure demonstrating the ninety-day cumulative oxycodone 5-mg equivalent filling for patients filling at least one opioid prescription within the 30PRE-90POST cohort. Error bars represent standard deviation. All years had significant reductions in opioid prescribing compared with 2010.

As shown in Table 4, 10 of 24 states (41.7%) with opioid legislation and 5 of 13 states (38.5%) without opioid legislation had large, significant reductions in initial prescription volume. The largest reductions were in states with low procedural volume without specific opioid legislation. Similarly, as shown in Table 5, 13 of 24 states (54.2%) that enacted opioid-limiting legislation and 6 of 13 states (46.2%) without opioid legislation had large (>5 oxycodone 5-mg pills), significant reductions in 90-day cumulative perioperative opioid prescribing.

Supplemental Digital Content, Figures E1 and E2, http://links.lww.com/JAAOS/A588, and http://links.lww.com/JAAOS/A589 display state-level mean opioid filling per year and demonstrate clear reductions in initial and 90-day cumulative opioid prescribing over time. Next, prelegislation opioid filling was compared with postlegislation opioid filling in states with and without formal legislation using the same parameters previously noted (Table 6). Although both groups achieved significant reductions in initial and 90-day cumulative prescription filling volume, the decreases were slightly larger in states with legislation compared with states without legislation (7 vs 5 oxycodone 5-mg pills at the initial prescription and 24 vs 17 oxycodone 5-mg pills in the cumulative 90-day period). The 7-pill difference in cumulative opioid filling in states with legislation compared with without legislation exceeded the 5-pill threshold for clinical significance, although the difference in initial prescription filling volume decrease (2 pills) did not reach this threshold.

Supplemental Digital Content, Appendix Tables 4–7, and http://links.lww.com/JAAOS/A587 display adjusted models of opioid filling including first prescription volume, cumulative prescription volume, and rates of fill or refill for the study time frames. Significant effects of age, preoperative opioid usage, CCI, year, and state on opioid prescribing were noted.

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