Many groups across the country are working to reduce overprescribing of opioids. Our new area of work is to add to the 2015 AMDG Interagency Guideline on Prescribing Opioids for Pain, endorsed by the Bree Collaborative in July 2015, on how many opioids should be prescribed after a patient has surgery. We have seen a lot of variability in this postoperative opioid prescribing.
Other organizations have already released specific guidelines. You can see guidelines for patients who have not used opioids before (called opioid naïve) from Johns Hopkins here and from the Michigan Surgical Quality Collaborative here but even these recommendations are different from one another. For an open or abdominal hysterectomy, Johns Hopkins recommends starting with acetaminophen and/or ibuprofen or Tramadol and if needed, 15 5mg tablets of Oxycodone, while Michigan recommends 25 5mg tablets of Oxycodone while counseling patients to “Take acetaminophen and ibuprofen around the clock, and use the stronger pain pills only as needed for breakthrough pain.” Like both groups, for all surgeries we recommend prescribing a nonsteroidal anti-inflammatory drug (NSAID) or combination of NSAID and acetaminophen for mild to moderate pain as first line therapy.
Our goal is to create usable guidelines for our community while keeping in mind that there is no optimal number of pills for a given procedure. Our recommendations are meant to serve as a general framework for managing postoperative pain, while minimizing leftover pills. We have spent months gathering the best evidence to date and convening clinical experts to develop recommendations grouped by procedures with a similar pain burden or a similar expected recovery rather than by specific procedure. We recommend that the rationale for any exceptions be well documented in the record. Even in these exceptions the initial prescription should not exceed two weeks.
Interested in being part of the conversation? Join at us tomorrow’s meeting from 3:00 – 5:00pm. All information about our opioid workgroup is on our website here.