Impact of state legislation in Tennessee on opioid prescribing practices of orthopedic surgeons

Corey Guidry, PharmD, BCPS; Blerim Dema, BSc; Corinne Allen, PharmD, MBA; David Stewart, PharmD, BCPS

doi:10.5055/jom.2022.0704

Authors

Corey Guidry, PharmD, BCPS https://orcid.org/0000-0003-3842-9059
Blerim Dema, BSc
Corinne Allen, PharmD, MBA
David Stewart, PharmD, BCPS

DOI:

https://doi.org/10.5055/jom.2022.0704

Keywords:

opioid, opioid epidemic, post-operative pain, legislation

Abstract

Objective: Post-operative patients are at increased risk of becoming chronic users of opioids, and overprescribing can lead to abuse and diversion. Though data have shown a decrease in opioid prescriptions nationally, limited studies have specifically evaluated the influence of state legislation on this trend. This study aimed to assess the impact of legislation in the state of Tennessee on opioid prescribing amongst orthopedic surgeons.

Design: This retrospective cohort analysis evaluated patients who received opioids post-orthopedic surgery before and after the state legislation was passed. Setting: A community teaching hospital.

Patients and participants: Two hundred and three post-orthopedic surgery patients were included, with 101 in the prelegislation and 102 in the post-legislation groups.

Interventions: State legislation in Tennessee limiting amounts of prescribed opioids went into effect in July 2018.

Main outcome measure(s): The primary outcome was total morphine milligram equivalents (MMEs) prescribed, with secondary outcomes of days’ supply, dosage units, and MME per day.

Results: Orthopedic surgery patients in the post-legislation arm were prescribed significantly fewer MME than those in the prelegislation arm (median MME 375 vs. 562.5; p < 0.001). Prescription days’ supply, number of dosage units, and MME per day were also significant lower in the post-legislation group.

Conclusions: After orthopedic surgery, patients in the post-legislation arm were prescribed a median 187.5 MME less than those in the prelegislation arm. Our findings suggest that state opioid legislation is associated with a reduction in the amount of opioids prescribed in certain orthopedic surgery patients, though further studies evaluating adequacy of pain control are warranted.

Author Biographies

Corey Guidry, PharmD, BCPS

Assistant Professor, Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma

Blerim Dema, BSc

Pharmacy Student, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee

Corinne Allen, PharmD, MBA

Director, Department of Pharmacy, Johnson City Medical Center, Johnson City, Tennessee

David Stewart, PharmD, BCPS

Professor, Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee

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