Opioid Prescribing by US Surgeons, 2016-2022

This cross-sectional study investigates the rate and dosing of opioid prescriptions among US surgeons from 2016 to 2022.


Introduction
US surgeons prescribe opioids more frequently than surgeons elsewhere. 1These prescriptions often exceed patient need, increasing diversion risk. 2 In response, policies and practice guidelines centered on opioid prescribing for acute pain have been implemented. 3,4mely national data on opioid prescribing by surgeons are important to inform ongoing stewardship initiatives.However, the most recent data on this prescribing come from 2019. 5 We addressed this gap using national data from 2016 to 2022.

Methods
This cross-sectional study used data from the IQVIA Longitudinal Prescription Database, which captures 92% of prescriptions dispensed in US retail pharmacies.Because data are deidentified, the Institutional Review Board of the University of Michigan exempted this study from review.This study follows the STROBE reporting guideline for cross-sectional studies.
We included opioid prescriptions from surgeons dispensed between 2016 and 2022.We excluded prescriptions for non-US patients and those with invalid or missing dosing data.Outcomes were the monthly surgical opioid dispensing rate (dispensed opioid prescriptions from surgeons per 100 000 people), monthly mean total morphine milligram equivalents (MMEs) per prescription (a standardized measure of prescription size), and monthly total MMEs per 100 000 people.
To assess trend changes, we fitted joinpoint regression models.We calculated unadjusted changes in outcomes between January 2016 and December 2022 by specialty.Analyses used Joinpoint Trend Analysis Software version 5.0.2 (National Cancer Institute) and 2-sided hypothesis tests with α = .05(eMethods in Supplement 1).

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Author affiliations and article information are listed at the end of this article.During January 2016 to December 2022, monthly total MMEs per 100 000 people decreased from 273 746 to 94 548 MMEs (65.5%).Similar to other outcomes, this quantity decreased less rapidly after mid-2020 compared with before 2020 (Figure , C).

Figure. Rate and
The Table shows changes in outcomes between January 2016 and December 2022 by specialty.
For orthopedic surgery, the specialty accounting for the most opioid dispensing, the opioid dispensing rate per 100 000 people declined from 301.7 to 184.9 MMEs (−38.7%) and mean total MMEs per prescription declined from 495.3 to 274.7 MMEs (−44.5%).

Discussion
This cross-sectional study found that during 2016 to 2022, the rate and size of opioid prescriptions from US surgeons declined, but these declines were slower after mid-2020 compared with before 2020.During the initial months of the COVID-19 pandemic, the opioid dispensing rate declined, potentially owing to decreased surgical volume, while opioid prescription size increased, potentially because surgeons wrote larger discharge prescriptions owing to barriers to obtaining refills.
However, these changes were transient.
Study limitations include lack of information on the specialty of advanced practice clinicians.
Because of this limitation, surgical opioid prescriptions from these clinicians could not be identified or included in analyses. 6spite large reductions in opioid prescribing, surgical opioid stewardship initiatives remain important.For example, the mean size of opioid prescription from surgeons was 44 pills in December 2022, more than patients typically need.