Evaluating Policy Interventions to Decrease Excessive and Risky Perioperative Opioid Prescribing

Project start date and end date: 2022 - 2026

Background:

At least 15.4 million opioid prescriptions in the United States are provided each year during surgical care, and many of these prescriptions are excessive or are written in a manner that increases the risk of opioid-related adverse events, such as overdose. To reduce these harms, policymakers and payers in most states have enacted policies that restrict opioid prescribing for acute pain or mandate clinicians to review prescription drug monitoring program databases before prescribing opioids, but it is not clear if these policies have reduced excessive and risky perioperative opioid prescribing, or if they have had unintended effects, such as worsened pain control.

Objectives:

  • Aim 1. Evaluate the effect of state prescribing limits on perioperative opioid prescribing and outcomes.
  • Aim 2. Evaluate the effect of PDMP use mandates on perioperative opioid prescribing and outcomes.
  • Aim 3. Evaluate the effect of opioid policies in Michigan on patient-reported outcomes.

Research Topics & Methods:

Using rigorous quasi-experimental methods, comprehensive medical claims from both privately and publicly insured adults, and data from a statewide Michigan surgical registry, we will evaluate the effects of these policies on perioperative opioid prescribing, high-risk prescribing, opioid-related adverse events, and patient-reported outcomes, thus revealing whether the policies should be expanded more broadly or whether other approaches are needed to mitigate the harms from perioperative opioid prescribing.

Implications:

This proposal will provide critical information for efforts to mitigate the contribution of perioperative opioid prescribing to the U.S. opioid epidemic. Innovations include use of national claims data with a combined sample size of 76 million adults, maximizing the breadth of analyses, coupled with use of data on patient-reported outcomes at the state level, maximizing the depth of analyses. Ultimately, findings will contribute to the development of well-designed policies that balance the need for safe opioid prescribing with the need for effective postoperative pain management.

Funder:

This project is funded by the National Institute on Drug Abuse.

Collaborators:

Jennifer Waljee (MPI); Thuy Nguyen (Co-I); Amy Bohnert (Co-I); Chad Brummett (Co-I)

For more information, please contact:
Co-Director, CHEAR Fellowship Programs
Associate Professor, Department of Pediatrics
Associate Professor, Department of Health Management and Policy
NCRC Building 16, G026W
2800 Plymouth Road
Ann Arbor, MI 48109-2800
Phone
734-615-6189
Email
chuak@med.umich.edu