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Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada

Grant, David W. M.D.; Power, Hollie A. M.D.; Vuong, Linh N. B.Sc.; McInnes, Colin W. M.D.; Santosa, Katherine B. M.D., M.S.; Waljee, Jennifer F. M.D., M.S.; Mackinnon, Susan E. M.D.

Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 126e-136e
doi: 10.1097/PRS.0000000000005780
Plastic Surgery Focus: Special Topics
Press Release
Patient Safety CME

Background: Overprescribing following surgery is a known contributor to the opioid epidemic, increasing the risk of opioid abuse and diversion. Trainees are the primary prescribers of these medications at academic institutions, and little is known about the factors that influence their prescribing. The authors hypothesized that differences in health care funding and delivery would lead to disparities in opioid prescribing. Therefore, the authors sought to compare the prescribing practices of plastic surgery trainees in the United States and Canada.

Methods: A survey was administered to trainees at a sample of U.S. and Canadian institutions. The survey queried opioid-prescriber education, factors contributing to prescribing practices, and analgesic prescriptions written after eight procedures. Oral morphine equivalents were calculated for each procedure and compared between groups.

Results: One hundred sixty-two trainees completed the survey, yielding a response rate of 32 percent. Opioid-prescriber education was received by 25 percent of U.S. and 53 percent of Canadian trainees (p < 0.0001). Preoperative counseling was performed routinely by only 11 percent of U.S. and 14 percent of Canadian trainees. U.S. trainees prescribed significantly more oral morphine equivalents than Canadians for seven of eight procedures (p < 0.05). Residency training in the United States and junior training level independently predicted higher oral morphine equivalents prescribed (p < 0.05).

Conclusions: U.S. trainees prescribed significantly more opioids than their Canadian counterparts for seven of eight procedures surveyed. Many trainees are missing a valuable opportunity to provide opioid counseling to patients. Standardizing trainee education may represent an opportunity to reduce overprescribing.

St. Louis, Mo.; Ann Arbor, Mich.; and Edmonton, Alberta, Canada

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine; the Section of Plastic Surgery, Department of Surgery, University of Michigan; and the Division of Plastic Surgery, University of Alberta.

Received for publication September 7, 2018; accepted January 10, 2019.

The authors listed first and second contributed equally to this work and should be considered a co–first author.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

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Hollie A. Power, M.D., Division of Plastic Surgery, Department of Surgery, University of Alberta, 2D2.08 Walter C. Mackenzie Health Sciences Centre, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada,, Twitter: @HolliePowerMD

Copyright © 2019 by the American Society of Plastic Surgeons