The impact of opioid prescribing reduction interventions on prescribing patterns across orthopedic subspecialties


  • Justin Turcotte, PhD, MBA
  • Kevin Crowley, MBA, MS, PT
  • Stephanie Adams, MEd
  • David Keblish, MD
  • Cyrus Lashgari, MD
  • Chad Patton, MD, MS
  • Benjamin Petre, MD
  • Paul King, MD
  • Jeffrey Gelfand, MD



opioid, narcotic, morphine, over prescribing, quality improvement


Objective: To date, the majority of studies have focused on the adverse effect of opioid overutilization on outcomes, risk factors for overutilization and dependence, and the development of procedure-specific guidelines. We present the results of a multiphased approach to reducing opioid prescribing.

Design: A retrospective pre-post study of opioid prescriptions across 386,393 patient encounters was conducted. The preintervention cohort included patient encounters from November 2016 to March 2017, and the post-intervention cohort included encounters from April 2017 to October 2019.

Setting: Single-institution orthopedic practice.

Patients, participants: 386,393 patient encounters.

Intervention: Multiple prescribing reduction interventions were implemented from April 2017 to July 2018.

Main outcome measure: Average morphine milligram equivalent (MME) per patient encounter.

Results: Implementation of the interventions resulted in an average reduction of 15.2 MME per encounter (54.5 percent) compared to the preimplementation cohort (pre: avg. MME = 27.9, SD 113.6; post: avg. MME = 12.7, SD 66.1; p < 0.001). The number of pills per opioid prescription was reduced by 13.4 (29.5 percent) (pre: avg. pill count = 45.5, S.D. 25.1; post: avg. pill count = 32.1, SD 21.1; p < 0.001), and the percent of patients receiving opioids was reduced from 8.3 percent to 5.8 percent (p < 0.001). Prescribing compliance was evaluated for 7,664 surgical encounters, with 98.2 percent of prescriptions meeting stated guidelines; 5.5 percent of these encounters required second prescriptions.

Conclusions: The use of a multiphase approach effectively reduced the opioid prescribing patterns of a large orthopedic practice and was successful across subspecialties. This approach provides a template that other institutions may use to reduce opioid overprescribing in orthopedic practices.

Author Biographies

Justin Turcotte, PhD, MBA

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

Kevin Crowley, MBA, MS, PT

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

Stephanie Adams, MEd

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

David Keblish, MD

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

Cyrus Lashgari, MD

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

Chad Patton, MD, MS

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

Benjamin Petre, MD

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

Paul King, MD

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland

Jeffrey Gelfand, MD

Department of Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland


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How to Cite

Turcotte, PhD, MBA, J., K. Crowley, MBA, MS, PT, S. Adams, MEd, D. Keblish, MD, C. Lashgari, MD, C. Patton, MD, MS, B. Petre, MD, P. King, MD, and J. Gelfand, MD. “The Impact of Opioid Prescribing Reduction Interventions on Prescribing Patterns across Orthopedic Subspecialties”. Journal of Opioid Management, vol. 17, no. 2, Mar. 2021, pp. 169-7, doi:10.5055/jom.2021.0626.