The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures
Excessive opioid prescribing is common in surgical oncology, with 72% of prescribed opioids going unused after curative-intent surgery. In this study, we sought to reduce opioid prescribing after breast and melanoma procedures by designing and implementing an intervention focused on education and prescribing guidelines, and then evaluating the impact of this intervention.
In this single-institution study, we designed and implemented an intervention targeting key factors identified in qualitative interviews. This included mandatory education for prescribers, evidence-based prescribing guidelines, and standardized patient instructions. After the intervention, interrupted time-series analysis was used to compare the mean quantity of opioid prescribed before and after the intervention (July 2016–September 2017). We also evaluated the frequency of opioid prescription refills.
During the study, 847 patients underwent breast or melanoma procedures and received an opioid prescription. For mastectomy or wide local excision for melanoma, the mean quantity of opioid prescribed immediately decreased by 37% after the intervention (p = 0.03), equivalent to 13 tablets of oxycodone 5 mg. For lumpectomy or breast biopsy, the mean quantity of opioid prescribed decreased by 42%, or 12 tablets of oxycodone 5 mg (p = 0.07). Furthermore, opioid prescription refills did not significantly change for mastectomy/wide local excision (13% vs. 14%, p = 0.8), or lumpectomy/breast biopsy (4% vs. 5%, p = 0.7).
Education and prescribing guidelines reduced opioid prescribing for breast and melanoma procedures without increasing the need for refills. This suggests further reductions in opioid prescribing may be possible, and provides rationale for implementing similar interventions for other procedures and practice settings.
Dr. Lee is a National Research Service Award postdoctoral fellow supported by the National Cancer Institute (5T32 CA009672-23). Drs. Englesbe, Waljee, and Brummett receive funding from the Michigan Department of Health and Human Services and the National Institute on Drug Abuse (RO1 DA042859). The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Michigan Department of Health and Human Services.
- 14.Dreyer T, Rontal R, Gabriel K, Udow-Phillips M. Uncoordinated prescription opioid use in Michigan. Ann Arbor, MI: Center for Healthcare Research and Transformation; Dec 2015. http://www.chrt.org/publication/uncoordinated-prescription-opioid-use-in-michigan/. Accessed 30 Mar 2018.
- 23.Mols F, Beijers T, Lemmens V, van den Hurk CJ, Vreugdenhil G, van de Poll-Franse LV. Chemotherapy-induced neuropathy and its association with quality of life among 2- to 11-year colorectal cancer survivors: results from the population-based PROFILES registry. J Clin Oncol. 2013;31(21):2699–2707.CrossRefGoogle Scholar
- 24.State and Federal Legislation Surrounding Initial Opioid Prescriptions. 2017. http://www.astho.org/StatePublicHealth/State-and-Federal-Legislation-Surrounding-Initial-Opioid-Prescriptions/03-08-18/. Accessed 22 Mar 2018.
- 27.Lopez Bernal J, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–355.Google Scholar
- 28.Michigan Opioid Prescribing Engagement Network. Opioid prescribing recommendations for surgery. https://opioidprescribing.info/. Accessed 27 Mar 2018.
- 31.Lipari RN, Hughes A. How people obtain the prescription pain relievers they misuse. The CBHSQ report. Rockville: Substance Abuse and Mental Health Administration; 2017. pp. 1–7.Google Scholar
- 34.Klueh MP, Hu HM, Howard RA, et al. Transitions of care for postoperative opioid prescribing in previously opioid-naïve patients in the USA: a retrospective review. J Gen Intern Med. Epub 11 Jun 2018. https://doi.org/10.1007/s11606-018-4463-1.