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Invited Commentary
January 2018

Addressing Variability in Opioid Prescribing

Author Affiliations
  • 1Department of Surgery, University of Chicago Medicine, Chicago, Illinois
JAMA Surg. 2018;153(1):43. doi:10.1001/jamasurg.2017.3166

Since the turn of the century, the United States has witnessed a dramatic increase in the misuse of opioid pain medications. According to the Centers for Disease Control and Prevention,1 the amount of opioid pain relievers sold in the United States has quadrupled since 1999. The overprescription of pain medications has been implicated as a driving force behind the opioid epidemic and the associated increases in deaths from overdose.2 Despite this recognition of opioid overprescription, few guidelines exist regarding the appropriateness of opioid prescriptions following surgery. In this issue of JAMA Surgery, Scully et al3 describe prescription patterns and appropriateness of opioid pain medications based on the rate of prescription refills following common surgical procedures. Analyzing data from the Department of Defense Military Health System Data Repository, they identified opioid-naive individuals 18 to 64 years of age who had undergone 1 of 8 common surgical procedures between 2006 and 2014. Of 215 140 individuals who received and filled at least 1 prescription for opioid pain medication within 14 days of their index procedure, 41 107 (19.1%) received at least 1 refill. They found significant variability by procedure type, ranging from a nadir probability of refill of 9 days for general surgery procedures to 13 days for women’s health procedures and 15 days for musculoskeletal procedures. They concluded that opioid prescriptions after surgery should balance adequate pain management with the duration of treatment.

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