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Comment & Response
July 9, 2019

Limiting Opioid Prescribing—Reply

Author Affiliations
  • 1Department of Pediatrics, University of Michigan, Ann Arbor
  • 2Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
  • 3Department of Surgery, University of Michigan Medical School, Ann Arbor
JAMA. 2019;322(2):171-172. doi:10.1001/jama.2019.5864

In Reply We agree with Dr Daoust that individualized opioid prescribing and co-analgesic prescribing should be considered. We also agree that preventing excessive opioid prescribing for acute pain is important to reduce misuse of unused opioids. In our Viewpoint,1 we questioned whether policy limits are the optimal mechanism to achieve this goal. On the one hand, even the most stringent 3-day limits still allow for prescribing that is higher than the amount consumed by the average patient with acute pain. For example, as we noted in our Viewpoint, median opioid consumption in a study of Michigan patients undergoing 1 of 12 surgical procedures was just 9 pills, the equivalent of a 1- to 2-day supply.2 On the other hand, lowering limits to levels that would be sufficient for the average patient could worsen pain control for many patients because of the underlying variability in pain needs, both between and within conditions. A 1- to 2-day supply might be sufficient for minor surgical procedures and for many conditions seen in the emergency department but would be well below the amount consumed by most patients undergoing major surgical procedures, such as total knee replacement.3

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