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Prescription Opioid Type and the Likelihood of Prolonged Opioid Use After Orthopaedic Surgery

Basilico, Matthew, AB, AM; Bhashyam, Abhiram R., MD, MPP; Harris, Mitchel B., MD; Heng, Marilyn, MD, MPH, FRCSC

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 1, 2019 - Volume 27 - Issue 9 - p e423–e429
doi: 10.5435/JAAOS-D-17-00663
Research Article

Introduction: A common belief is that some narcotic medications have a higher association with prolonged use. We assessed whether the initial opiate type prescribed to postoperative, opiate-naive orthopaedic trauma patients was associated with prolonged opioid use.

Methods: We studied 17,961 adult, opiate-naive patients treated for a surgical musculoskeletal injury. Discharge prescription in morphine milligram equivalents (MMEs, a standardized dosing unit that allows for comparison across opioid types) was calculated. Opioid prescribing beyond 90 days after injury was defined as prolonged use.

Results: Initial analysis demonstrated a higher likelihood of prolonged use for patients discharged on hydromorphone or morphine versus hydrocodone. However, when we adjusted for discharge MME, only opioid quantity was predictive of prolonged use (P < 0.001). In addition, discharge MME was associated with opioid type (P < 0.01).

Discussion: Persistent opiate use was associated with discharge opioid quantity, not the opioid type. These results highlight the importance of calculating equivalence doses when selecting opioid types and considering amount of narcotics prescribed.

Level of Evidence: Level III

From the Department of Economics (Mr. Basilico), Harvard University and Harvard Medical School, the Harvard Combined Orthopaedics Residency Program (Dr. Bhashyam), the Department of Orthopaedic Surgery (Dr. Harris), Massachusetts General Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, and the Department of Orthopaedics (Dr. Heng), Massachusetts General Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Cambridge, MA.

Correspondence to Dr. Bhashyam:

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health. Mr. Basilico is supported by a Predoctoral Fellowship in Aging and Health Economics (NIA T32 AG 51108) from the National Institute on Aging. We thank David Cutler, PhD; Nihar Shah; Michael Weaver, MD; and Mark Vrahas, MD, for their helpful comments.

Dr. Heng or an immediate family member serves as a board member, owner, officer, or committee member of the New England Orthopaedic Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Basilico, Dr. Bhashyam, and Dr. Harris.

Mr. Basilico and Dr. Bhashyam contributed equally to this work.

© 2019 by American Academy of Orthopaedic Surgeons
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