The August 2014 edition of the Journal of Bone and Joint Surgery includes a study on the postoperative narcotic use and physician shopping among orthopedic trauma patients and trends to watch in the future.
The study authors gathered complete data from 130 patients in a prospective cohort study using the state-controlled substance monitoring database to identify narcotic patients that filled prescriptions three months before admission and six months following discharge. The study was conducted in Tennessee and data presented at the American Academy of Orthopaedic Surgeons annual meeting.
The key trends they discovered include:
1. 8.5 percent of patients reported preoperative narcotic use, defined as having three or more narcotic prescriptions within three months of admission.
2. 20.8 percent of patients sought multiple narcotic providers postoperatively — meaning those patients went "doctor shopping."
3. Postoperative narcotic prescriptions increased significantly between the single-narcotic provider group — reporting two prescriptions — and the multiple narcotic provider group — reporting seven prescriptions.
4. The average length of narcotic use among the single-narcotic provider group was 28 days. By comparison, the narcotic use for the multiple-narcotic provider group was 110 days.
5. The morphine equivalent dose per day for the single-narcotic provider group was 26 mg, and for the multiple-narcotic provider group it was 43 mg per day.
6. The patients with a maximum high school education or less were 3.2 times more likely to seek multiple providers.
7. Patients with a preoperative narcotic use history were 4.5 times more likely to seek multiple providers.
8. A separate report from AAOS shows recreational narcotic use has grown significantly over the past few decades. In 1990, an estimated 627,000 people used narcotics recreationally, but that number grew to around 2.2 million by 2005 and many of these people obtain pills from family and friends.
9. More than 50 million Americans were prescribed some type of narcotic pain medication in 2011, nearly double the number who used narcotics just three years earlier in 2008. The increase could signify an upswing in medication divergence.
10. 99 percent of the world's narcotics are consumed in the United States, with the number of per capita retail purchases of hydrocodone increasing four-fold from 1997 to 2007, oxycodone purchases increasing nine-fold and methodone use increasing 13-fold. At the same time, opioid fatalities jumped 68 percent.