High-Dose Opioids Are Common Following Knee Arthroscopy, Despite CDC Recommendations
Despite opioid prescription rates for outpatient knee surgery varying drastically from state to state, a higher-than-recommended dosage was consistent across the board, according to a recent study.1 The observed median dosage matched the dosage identified by the Centers for Disease Control and Prevention as being linked to an increased risk of overdose death.
The researchers analyzed data from a national database of insurance claims to measure opioid prescription rates among 98,623 individuals who underwent knee arthroscopy between 2015 and 2019. They then calculated the morphine milligram equivalent (MME) dose per prescription.
Overall, the researchers determined that the median patient received a dosage equivalent to 50 MME per day. Of the 98,623 patients, 36% were taking this dosage level or higher.
This high dosage is particularly notable as this study concentrated on patients without a history of opioid use. Prior studies have shown that high dosages of opioids prescribed to opioid-naïve patients can contribute to the current opioid epidemic, as they can be associated with long term opioid use, higher numbers of leftover pills, and higher rates of overdose among family members.
The researchers also noted significant differences in the number of prescriptions between states. Rates were lowest in South Dakota at 40%, while those in Nebraska were more than double that (85%). These numbers persisted following adjustment for confounding factors such as possible state policies, the nuances of the procedures, and differences in patient characteristics. Arthroscopic knee surgery was strategically chosen as the focus as this type of procedure is within the top 3 most common procedures in the United States.
“These studies suggest that current prescribing patterns are still resulting in a significant number of opioid tablets in the community that could be misused and potentially diverted to others,” concluded senior author M. Kit Delagado, MD, in a press release.2 “The data we’ve collected show that there’s ample opportunity to reduce excessive prescribing for this common outpatient procedure.”
—Leigh Precopio
References:
- Ukert B, Huang Y, Sennett B, Delgado K. State-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015-2019. July 16, 2020. BMJ Open. 2020;10:e035126. doi:10.1136/bmjopen-2019-035126
- Opioid prescription rates for knee surgery patients vary, but higher strength dosage common. News release. Penn Medicine News. August 25, 2020. Accessed August 26, 2020. https://www.pennmedicine.org/news/news-releases/2020/august/opioid-prescription-rates-for-knee-surgery-patients-vary-but-higher-strength-dosage-common