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Comment & Response
April 24, 2019

Opioid Prescription After Surgery—Reply

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
JAMA Surg. 2019;154(7):675-676. doi:10.1001/jamasurg.2019.0574

In Reply We appreciate the comments from Kurokawa et al regarding our recent study looking at opioid prescription and consumption after surgery.1 These comments are primarily directed at the inherent biases of retrospective analysis, which we acknowledge as a limitation in our article. First, they raise the point of possible confounding from patients with a history of substance use or previous opioid use. In 2018, Hilliard et al2 demonstrated that nearly 1 in 4 patients undergoing surgery report preoperative opioid use. Therefore, our cohort certainly included these patients, although this characteristic was not collected as part of the data set. Kurokawa et al may be suggesting that surgeons prophylactically prescribe larger prescriptions to patients who use opioids preoperatively. Conversely, we found in a national insurance data set that clinicians do not tend to increase prescription sizes for patients with preoperative use unless the patient uses large amounts of opioids chronically.3 If these patients consumed more of their prescription (of any size) than opioid-naive patients, the observed association may be weakened. In addition, it has been previously demonstrated in opioid-naive patients that patients who receive smaller opioid prescriptions use less medication.4 We have begun collecting preoperative opioid use data in this data set, and future analysis will help us to understand how preoperative substance or opioid use influences postoperative opioid use. Nevertheless, prescription size seems to play an important role.

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