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Invited Commentary
December 10, 2020

Curtailing Opioid Overprescribing in Ophthalmology

Author Affiliations
  • 1Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Philadelphia Retina Associates, Philadelphia
  • 3Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 4Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Ophthalmol. 2021;139(2):162-164. doi:10.1001/jamaophthalmol.2020.5435

Although we are in the midst of the coronavirus disease 2019 pandemic, the opioid epidemic rages on. From 1999 to 2018, approximately 450 000 people died from opioid overdose, with approximately 50 000 deaths in 2018 alone, highlighting the dramatic increases in these alarming trends.1 As a field, ophthalmology has taken an active approach to analyzing and modifying its own opioid prescribing practices. Patel and Sternberg2 analyzed Medicare Part D prescriber data and showed that approximately 90% of ophthalmologists wrote 10 or fewer opioid prescriptions yearly, with an average of 7 prescriptions for a mean of 5 days of drug coverage.2 Shortly after, Kolomeyer et al3 showed that the odds of filling an opioid prescription after any incisional ocular surgery was 3.3 times higher in 2016 than in 2000 to 2001. Together, these studies demonstrated that although the ophthalmic use of opioids was not high across the specialty, similar to the rest of medicine, it had dramatically increased. Recognizing this trend, studies have focused on developing and instituting guidelines aimed at decreasing postoperative opioid prescriptions. Woodward et al4 used updated opioid prescribing guidelines to demonstrate a significant decrease in prescribed opioids after corneal surgery with adequate postoperative patient-reported pain control. Starr et al5 described the effect of standardizing postoperative opioid prescribing guidelines for patients undergoing a variety of ophthalmic surgeries. After implementation, the rate, strength, and total amount of opioid prescribed decreased significantly. Importantly, the proportion of refilled prescriptions also did not change, implying adequate pain control with considerable reduction in potential for opioid misuse.

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