A recent study led by the Perelman School of Medicine at the University of Pennsylvania has analyzed the rate of opioid prescriptions filled for all incisional ocular surgeries from 2000 through 2016 and found an increasing trend. The highest increase was observed from 2000 to 2014, despite the reduced invasiveness of these procedures.
Opioid overdoses accounted for over 47,000 deaths in 2017, more than any previous year on record, according to the U.S. Department of Health and Human Services (HHS). Many experts have attributed the current opioid epidemic to a rise in prescription opioid medications in the ‘90s and early 2000s, which led to their widespread misuse. In response to the opioid crisis, the HHS released a report in 2019 on acute and chronic pain management, and governing bodies of some medical specialties have created specific guidelines for opioid prescribing. However, given the few number of studies that characterize how opioids are used in ophthalmic settings, there are no specific guidelines for their use in eye surgery.
The University of Pennsylvania team used data from a large national U.S. insurer’s medical claims database to evaluate filled prescriptions between years 2000 and 2016. (The years 2000 and 2001 were combined due to a low number of surgeries meeting inclusion criteria in 2000.) In total, 2,407,962 incisional ocular surgeries were included in the study, and patients from all 50 states were represented. While only 45,776, or about 2 percent of all surgeries, were associated with an opioid prescription, the researchers found a steady rise from 2000 to 2014. Grouping the years into four to five-year cohorts also showed a similar trend.
The overall rate of filled opioid prescriptions after these procedures more than doubled, from 1.2 percent in 2000-01 to 2.5 percent in 2014, across six different ocular subspecialties. Rates dropped for the first time during this time period to 2.2 percent in 2015 and then to 2.1 percent in 2016. However, the researchers found that after controlling for differences among the types of surgeries, the odds of having an opioid medication filled after any incisional ocular surgery were over three times higher in 2014-16 compared to 2000-04.
In its publication, the study concluded: “These findings suggest the rate of filled opioid prescriptions are increasing for all types of incisional ocular surgery over time. Given the ongoing national opioid epidemic, understanding patterns of use can help in reversing the epidemic.”
“It is our hope that these findings shed light on the trends in opioid medication filling patterns after incisional surgery and will motivate clinicians to evaluate their opioid medication prescribing practices,” said the study’s first author Anton M. Kolomeyer, MD, PhD, who was a fellow at Penn Medicine when he conducted the study. As a caveat, the study authors noted that they analyzed data for “prescriptions filled” rather than “prescriptions written,” and that they were unable to look at numbers past 2016 when the HHS declared opioid use a public health emergency.
Full news release: https://www.pennmedicine.org/news/news-releases/2019/september/opioid-prescriptions-filled-after-eye-surgery-doubled-from-2000-to-2014
Source: University of Pennsylvania