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J Am Acad Orthop Surg. 2019 May 1;27(9):e423-e429. doi: 10.5435/JAAOS-D-17-00663.

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

Author information

1
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.

Abstract

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.

PMID:
30289795
DOI:
10.5435/JAAOS-D-17-00663

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