A research article published in the Journal of the American Academy of Orthopaedic Surgeons from Boston-based orthopedic surgeon Marilyn Heng, MD, shows that it's quantity of opioids prescribed, rather than the type, that relates to long-term use in patients post-op.
The researchers' goal was to determine if the initial opiate type prescribed was tied to prolonged opioid use. Dr. Heng posits that the results "demonstrate how current beliefs about the mechanism of prolonged use may be confounded."
Six details:
1. The researchers studied almost 18,000 adult patients who had surgery for a traumatic musculoskeletal injury.
2. None of the patients had a history of opioid abuse, nor taken opioids in the six months prior to surgery. Prolonged opioid use was defined as beyond 90 days of initial prescription.
3. To account for differing strengths of opioids per milligram, the researchers determined the morphine milligram equivalents among all opioids prescribed to the sample population upon discharge.
4. Results indicated that prolonged opioid use correlates to the overall MME prescribed at discharge, rather than opioid type.
5. Researchers identified a pattern of failure to properly calculate an equivalence dose among opioid types and suggested the lack of conversion can lead to higher doses, placing patients at a larger risk for prolonged use.
6. Dr. Heng believes that there is a bias in how providers prescribe drugs, focusing "on the number of tablets" rather than MME, when it's MMEs "that make a difference."
Prescription opioids significantly contributed to the rise in drug-related deaths in the last decade with orthopedic surgeons ranking as the third highest prescribers of opioids among U.S. physicians, according to the National Survey on Drug Use and Health.