Opioid Prescribing: Too Much vs Not Enough
Find out how much you know about which patients are at a higher risk for opioid misuse vs those that can benefit from them with this 10-question quiz.
Question 1. True or false? A study of opioid-naïve youths (mean age 17 yrs) who underwent a medical procedure found that those with long-term familial opioid exposure* were more likely to receive an initial postoperative opioid prescription vs those without such exposure.
*Long-term opioid use among any family member, defined as having 1 or more family members who (1) filled opioid prescriptions totaling 120 days’ supply or more during the 12 months before the procedure date or (2) filled 3 or more opioid prescriptions in the 90 days before the procedure date. This level of opioid use was associated with an increased risk of opioid overdose mortality.
Answer: B. False. A study of 346 251 opioid-naïve youths who underwent common surgical or dental procedures, found that there was essentially no difference in the percentage of those receiving an initial postoperative opioid prescription between those exposed to long-term opioid use in a family member (79%) vs those without such exposure (74%) (P<.001).1
Question 2. True or false? Among opioid-naïve youths who had an initial opioid prescription fill, those with long-term familial opioid exposure were more likely to have an additional postoperative prescription (refill)* vs those without such exposure.
*Additional opioid prescriptions were those filled during the “secondary” postoperative period, ie, days 4-90.
Answer: A. True. Among the 257 085 opioid-naïve youths with an initial postoperative opioid prescription fill, 22.8% of those exposed to long-term opioid use in a family member had an opioid refill vs 11.6% of those without such exposure.1
Question 3. True or false? Among opioid-naïve youths who had an initial opioid prescription fill, those with long-term familial opioid exposure were less likely to have persistent opioid use* vs those without such exposure.
*Persistent opioid use, defined as the occurrence of 1 or more opioid prescription fills 91 to 180 days after the procedure date among patients with 1 or more initial opioid prescription fills.
Answer: B. False. Among youths with an initial opioid prescription fill, 4.1% of those who were exposed to long-term opioid use in a family member had persistent opioid use vs 2.4% of those without such exposure.1
Question 4. Study authors concluded which of the above based on their findings?
Answer: D. All of the above. The authors also note the need for more research to identify what factors may be involved in the greater need for opioids among those with family members who are long-term opioid users.1
Question 5. In a study of postoperative pain,* which of the above factors was NOT associated with the likelihood of a higher level of pain?
*Scheduled for thoracotomy, video-assisted thoracoscopic surgery, total hip replacement, total knee replacement, mastectomy, breast lumpectomy, hand surgery, carpal tunnel surgery, knee arthroscopy, shoulder arthroplasty, or shoulder arthroscop.
Answer: B. Male sex. Female sex, level of postoperative pain, and history of drug and alcohol abuse treatment were found to be associated with higher levels of postoperative pain.2
Question 6. In the same study, which of the above was the best postoperative predictor of remote pain resolution, opioid cessation, and complete surgical recovery?
Answer: B. Worst pain intensity over past 24 hours reported on postoperative day 10. Study authors were uncertain about the reason for this finding; they did report that during postoperative days 1-9, there was a great deal of variability in pain level and that its predictive value was minimal.2
Question 7. A recent analysis found that in the US in 2017, approximately what percentage of the 70 237 fatal drug overdoses involved prescription opioids?
Answer: B. 24.2%. In 2017, 17 029 (24.2%) of 70 237 opioid-related fatalities involved prescription opioids.3
Question 8. The same analysis found that higher rates of US opioid-related deaths currently occur in rural areas, urban areas, or about the same in both?
Answer: A. Rural areas. According to CDC data, 14 rural counties were among the 15 counties with the highest opioid prescribing rates in 2017.3
Question 9. Compared to urban areas, how much more likely was it for patients in rural areas to receive an opioid prescription from a primary care provider?
Answer: D. >75% more likely. Patients in rural counties were 87% more likely to receive a prescription for an opioid from a primary care provider vs those in urban counties (9.6% vs 5.2%, respectively).3
Question 10. Which of the above is NOT a possible explanation for higher rates of opioid prescribing in rural areas?
Answer: C. Rural providers have less training in pain management. There is no evidence that there is any difference between levels of education on pain management between rural and urban prescribers.3
References:
1. Harbaugh CM, Lee JS, Chua KP, et al. Association between long-term opioid use in family members and persistent opioid use after surgery among adolescents and young adults [published ahead of print February 27, 2019]. JAMA Surg. doi: 10.1001/jamasurg.2018.5838.
2. Hah JM, Cramer E, Hilmoe H, et al. Factors associated with acute pain estimation, postoperative pain resolution, opioid cessation, and recovery: Secondary analysis of a randomized clinical trial. JAMA Netw Open. 2019;2:e190168.
3. GarcÃa MC, Heilig CM, Lee SH, et al. Opioid prescribing rates in nonmetropolitan and metropolitan counties among primary care providers using an electronic health record system – United States, 2014-2017. MMWR Morb Mortal Wkly Rep. 2019;68:25-30.
Finding the balance between prescribing opioids to patients who truly benefit from them and those who might end up misusing them is a growing challenge for primary care physicians. Are there identifiable environmental factors that fuel the progression from using the analgesics as standard of care to potential abuse?Three recent studies look at external influences on patient opioid use and physician prescribing practices. This 10-question quiz will test your insight.
