Influence of opioid limiting legislation on patient narcotic usage and provider burden in orthopedic trauma

Porter Young, MD; David Michel, MD; Anthony Bell, MD

doi:10.5055/jom.2022.0692

Authors

Porter Young, MD https://orcid.org/0000-0002-8820-2146
David Michel, MD
Anthony Bell, MD

DOI:

https://doi.org/10.5055/jom.2022.0692

Keywords:

opioids, orthopedic trauma, legislation

Abstract

Objective: Opiate consumption in the United States has reached alarming levels. As a result, the state of Florida enacted House Bill 21 (HB21) in July 2018. Following HB21, we hypothesized total opioids prescribed would decrease, with a resulting increase in phone calls, unscheduled visits for pain control, and refills dispensed.

Design: Retrospective cohort study comparing opiate usage 6 months before and after HB21 enactment.

Setting: Single Level I academic trauma center.

Participants: Patients with isolated lower extremity fractures who were treated with a single surgery.

Intervention: Opioid prescription limitations according to Florida's HB21.

Main outcome measures: We compared morphine milligram equivalents (MMEs) dispensed at discharge, length of stay (LOS), readmissions, emergency room (ER) visits, calls for pain control, refills, and total MMEs dispensed for 3 months postoperatively.

Results: A total of 116 patients met inclusion criteria. Our results demonstrated a decrease in the median MMEs provided at discharge (288 vs. 184, p 0.005) and total MMEs dispensed (375 vs. 225, p 0.0003). There was no significant difference in LOS (2 vs. 2.5 days, p 0.979), unscheduled clinic visits for pain (two per group), ER visits for pain (eight per group), or phone calls for pain (13 vs. 9, p 0.344). There were no readmissions for pain control pre-HB21 and one post-HB21. The percentage of patients obtaining >1 refill decreased from 22.4 to 1.7 percent (p 0.002).

Conclusions: Legislation restricting opioid pain medications may be effective in decreasing opiate use in orthopedic trauma patients while decreasing provider burden.

Author Biographies

Porter Young, MD

Orthopaedic Surgery, University of Florida–Jacksonville, Jacksonville, Florida

David Michel, MD

Scripps Clinic, La Jolla, California. Michael Wolverton, MD, University of Florida–Jacksonville, Jacksonville, Florida

Anthony Bell, MD

Mercy Health, Springfield, Missouri

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