Patients undergoing surgery appear to be prescribed more opioids than are needed, using only 27% of the drugs prescribed from them. In a recent study from the USA, the number of dosage units had the strongest association with opioid consumption after surgery, with patients using an additional 5 pills for every 10 extra pills prescribed. Patients were included in the study if prescribed an opioid after surgery – 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed, although patient-reported pain in the week after surgery was also significantly associated with consumption this association was not as strong as the relationships observed for prescription size. Other factors that were noted to be influential included history of tobacco use, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5  pills vs 37  pills; P < .001).
This study indicates an area of “low hanging fruit” that is ripe for an intervention: if pharmacists and doctors can work together to more appropriately tailor the prescribing of power pain medicines to patient needs, the overall risk of opioid overuse and iatrogenic contribution to drug dependence may be reduced – hospitals seem to be the ideal place to work on this issue.