Attitudes and self-reported practices of orthopedic providers regarding prescription opioid use


  • Deepa Kattail, MD, MHS
  • Aaron Hsu, MHS
  • Myron Yaster, MD
  • Paul T. Vozzo, BA
  • Shuna Gao, BA
  • John M. Thompson, MD
  • Debra L. Roter, DrPH
  • Dawn Laporte, MD
  • R. Frank Henn 3rd, MD
  • John E. Fiadjoe, MD
  • Constance L. Monitto, MD



acute postoperative pain, opioid epidemic, risk mitigation


Objective: Orthopedic surgeons are the third-highest opioid prescribers in the United States. Their prescribing practices can significantly affect the quantity of unconsumed opioids available to fuel the current opioid epidemic. The aim of this study was to identify prescribing patterns and knowledge gaps among orthopedic providers for targeted future interventions and investigation.

Design: An online survey describing six common orthopedic surgical scenarios was distributed electronically to determine opioid type and quantity prescribed at discharge, medication disposal instructions, and the use of prescription drug monitoring programs (PDMPs) in the prescription writing process.

Setting: Tertiary care academic hospitals.

Participants: Orthopedic physicians and mid-level providers practicing at Johns Hopkins Medical Institutions and University of Maryland Medical System. Of 179 providers contacted, 127 (71 percent) completed the survey.

Main outcome measures: Quantity of opioid prescribed, utilization of PDMPs, and provision of opioid disposal instructions.

Results: While statistically significant associations were identified between quantity of opioid prescribed and surgical procedure, for five of six scenarios 95 percent of respondents recommended prescribing >55 oxycodone 5 mg pill equivalents (PEs) at discharge. An inverse correlation between years of clinical practice and mean number of PEs prescribed was observed. Fewer than 40 percent of respondents modified prescribing when presented with clinically relevant changes in scenario (history of depression or drug abuse). Over 60 percent of respondents do not use PDMPs, and 79 percent do not provide opioid disposal instructions.

Conclusions: Our findings support a need for targeted education to mitigate the role of orthopedic postoperative prescribing practices on the current opioid abuse epidemic.

Author Biographies

Deepa Kattail, MD, MHS

Assistant Professor, Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada

Aaron Hsu, MHS

Research Assistant, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Myron Yaster, MD

Professor, Department of Anesthesiology, University of Colorado-Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado

Paul T. Vozzo, BA

Research Assistant, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Shuna Gao, BA

Research Assistant, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

John M. Thompson, MD

Fellow, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland

Debra L. Roter, DrPH

Professor, Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Dawn Laporte, MD

Professor, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland

R. Frank Henn 3rd, MD

Associate Professor, Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, Maryland

John E. Fiadjoe, MD

Assistant Professor, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Constance L. Monitto, MD

Assistant Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland


Campbell JN: The fifth vital sign revisited. Pain. 2016; 157: 3-4.

Quinones S: Dreamland: The True Tale of America’s Opiate Epidemic. New York, NY: Bloomsbury Press, 2015.

Soffin EM, Waldman SA, Stack RJ, et al.: An evidence-based approach to the prescription opioid epidemic in orthopedic surgery. Anesth Analg. 2017; 125: 1704-1713.

Bicket MC, Long JJ, Pronovost PJ, et al.: Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017; 152: 1066-1071.

Katz J: Drug deaths in America are rising faster than ever. The New York Times. June 5, 2017. Available at Accessed October 6, 2017.

Rudd RA, Seth P, David F, et al.: Increases in drug and opioid-involved overdose deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452.

Kaafarani HM, Weil E, Wakeman S, et al.: The opioid epidemic and new legislation in Massachusetts: Time for a culture change in surgery? Ann Surg. 2017; 265: 731-733.

Morris BJ, Mir HR: The opioid epidemic: Impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015; 23: 267-271.

Lovecchio F, Derman P, Stepan J, et al.: Support for safer opioid prescribing practices: A catalog of published use after orthopaedic surgery. J Bone Joint Surg Am. 2017; 99: 1945-1955.

CRISP: The Maryland Prescription Drug Monitoring Program (PDMP). Available at Accessed August 6, 2018.

UNC School of Medicine: Opiate equianalgesic dosing chart. Available at Accessed December 27, 2018.

Sabatino MJ, Kunkel ST, Ramkumar DB, et al.: Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Joint Surg Am. 2018; 100: 180-188.

CDC: Opioid prescribing: Where you live matters. Available at Accessed January 5, 2018.

Gawande AA: It’s time to adopt electronic prescriptions for opioids. Ann Surg. 2017; 265: 693-694.

Manchikanti L, Abdi S, Atluri S, et al.: American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2—Guidance. Pain Physician. 2012; 15: S67-S116.

Miotto K, Kaufman A, Kong A, et al.: Managing co-occurring substance use and pain disorders. Psychiatr Clin North Am. 2012; 35: 393-409.

Kumar K, Kirksey MA, Duong S, et al.: A review of opioid-sparing modalities in perioperative pain management: Methods to decrease opioid use postoperatively. Anesth Analg. 2017; 125: 1749-1760.

Marquez-Lara A, Hutchinson ID, Nunez FJr, et al.: Nonsteroidal anti-inflammatory drugs and bone-healing: A systematic review of research quality. JBJS Rev. 2016; 4: 1-14.

Serper M, Wolf MS, Parikh NA, et al.: Risk factors, clinical presentation, and outcomes in overdose with acetaminophen alone or with combination products: Results from the acute liver failure study group. J Clin Gastroenterol. 2016; 50: 85-91.

Cozowicz C, Poeran J, Zubizarreta N, et al.: Trends in the use of regional anesthesia: Neuraxial and peripheral nerve blocks. Reg Anesth Pain Med. 2016; 41: 43-49.

Tsirigotis K, Gruszczynski W, Tsirigotis M: Gender differentiation in methods of suicide attempts. Med Sci Monit. 2011; 17: PH65-PH70.

Webster LR: Risk factors for opioid-use disorder and overdose. Anesth Analg. 2017; 125: 1741-1748.

Waljee JF, Li L, Brummett CM, et al.: Iatrogenic opioid dependence in the United States: Are surgeons the gatekeepers? Ann Surg. 2017; 265: 728-730.

Delcher C, Wagenaar AC, Goldberger BA, et al.: Abrupt decline in oxycodone-caused mortality after implementation of Florida’s prescription drug monitoring program. Drug Alcohol Depend. 2015; 150: 63-68.

US Food and Drug Administration: Medicine disposal: Questions and answers. Available at Accessed December 14, 2017.

US Environmental Protection Agency: How to dispose of medicines properly. Available at Accessed June 8, 2018.

Gamberini L, Petrucci G, Spoto A, et al.: Embedded persuasive strategies to obtain visitors’ data: Comparing reward and reciprocity in an amateur, knowledge-based website. In de Kort Y, IJsselsteijn W, Midden C, et al. (eds.): Persuasive Technology: Second International Conference on Persuasive Technology, PERSUASIVE 2007, Palo Alto, CA, USA, April 26-27, 2007. New York, NY: Springer, 2007.

Graffeo M, Ritov I, Bonini N, et al.: To make people save energy tell them what others do but also who they are: A preliminary study. Front Psychol. 2015; 6: 1287.

Bicket MC, Kattail D, Yaster M, et al.: An analysis of errors, discrepancies, and variation in opioid prescriptions for adult outpatients at a teaching hospital. J Opioid Manag. 2017; 13: 51-57.



How to Cite

Kattail, MD, MHS, D., A. Hsu, MHS, M. Yaster, MD, P. T. Vozzo, BA, S. Gao, BA, J. M. Thompson, MD, D. L. Roter, DrPH, D. Laporte, MD, R. F. Henn 3rd, MD, J. E. Fiadjoe, MD, and C. L. Monitto, MD. “Attitudes and Self-Reported Practices of Orthopedic Providers Regarding Prescription Opioid Use”. Journal of Opioid Management, vol. 15, no. 3, May 2019, pp. 213-28, doi:10.5055/jom.2019.0505.