P005: IMPACT OF FLORIDAS NEW LAW ON OPIOID PRESCRIPTIONS FOR ACUTE PAIN AFTER SURGERY AT A LARGE ACADEMIC CENTER
Alain C Marcelin, MD, Paul P Potnuru, MD; Jackson Memorial Hospital
Introduction: Drug overdose deaths, caused primarily by opioids, have tripled in the US between 1999 and 2015.1 In response to the national opioid crisis, Florida implemented House Bill 21 (HB 21) on July 1, 2018 to reduce the supply of circulating opioids.2 The law limits opioid prescriptions for acute pain to a 3-day supply. This limit can be extended up to 7 days if medically necessary. This extension mandates specific documentation on the written prescription and the medical record. This limitation does not apply to traumatic injuries with Injury Severity Score ≥9 or chronic pain. Several states enacted laws with day supply limits on opioid prescriptions for acute pain3 but their impact is poorly understood, particularly in surgical patients. In this retrospective study, we aim to characterize the immediate impact of Florida’s new law on opioid prescription practices for acute pain after outpatient surgery at a large public teaching hospital.
Methods: An IRB waiver was granted to review opioid prescriptions for outpatient surgeries at Jackson Memorial Hospital from July 2017 to August 2018. We included outpatients ≥18 years of age who underwent the following surgeries: cholecystectomy, appendectomy, hernia repair, hysterectomy, colectomy, mastectomy, and lymph node dissection. For each encounter, we obtained de-identified data including age, sex, surgical procedure, surgery duration, and opioid prescriptions at discharge. We calculated the total milligram morphine equivalents (MME) prescribed and MME per day for each encounter. The data was divided into two cohorts: before (July 2017-June 2018) and after (July 2018-August 2018) implementation of the law. Categorical data was compared using the Chi-squared test and continuous data was compared using Student's t-test.
Results: We analyzed 1065 outpatient surgical encounters (Table). Cohorts before (n=904) and after (n=161) implementation of the law were similar with respect to sex (P = 0.335), age (P = 0.477), and surgery duration (P=0.266). After implementation of the law, the proportion of patients receiving opioid prescriptions significantly decreased (93.3% vs. 60.9%; P<.001), the mean MME prescribed decreased by 40.6 (95% CI 28.7-52.4; P<0.001), and fewer patients received opioid prescriptions for >3 days (74.3% vs. 23.5%; P<0.001). Among patients receiving opioid prescriptions, the mean MME prescribed per day increased by 5.5 (95% CI 2.1-8.9; P=0.002) after implementation.
Discussion: Florida’s new controlled substances law, HB 21, had an immediate and significant impact in decreasing opioid prescriptions after outpatient surgery at our institution. Fewer patients received opioid prescriptions, less MME of opioids were prescribed, and more patients received ≤ 3 days of opioids. However, providers prescribed higher MME per day—a possible unintended consequence of restricting the duration but not the amount or dosage of opioid prescriptions. Our data presents a snapshot of the immediate, short-term effect of this new law. Further investigation of the law’s long-term impact on opioid prescriptions and potential secondary consequences (e.g. inadequate postsurgical analgesia, emergency room visits for pain, overdose deaths) are warranted.