Adherence to legislation limiting opioid prescription duration following musculoskeletal injury

Authors

  • Meghan K. Wally, PhD https://orcid.org/0000-0003-4540-532X
  • Michael E. Thompson, DrPH
  • Susan Odum, PhD
  • Donna M. Kazemi, PhD
  • Joseph R. Hsu, MD
  • Michael Beuhler, MD
  • Michael Bosse, MD
  • Manuel Castro, MD
  • Michael Gibbs, MD
  • Christopher Griggs, MD
  • Steven Jarrett, PharmD
  • Daniel Leas, MD
  • James Rachal, MD
  • Tamar Roomian, MS, MPH
  • Michael Runyon, MD
  • Animita Saha, MD
  • Brad Watling, MD
  • Ziqing Yu, MS
  • Rachel B. Seymour, PhD

DOI:

https://doi.org/10.5055/jom.2023.0804

Keywords:

opioids, legislation, musculoskeletal pain

Abstract

Objectives: North Carolina had implemented legislation (Strengthen Opioid Misuse Prevention (STOP) Act) limiting opioid prescriptions to 5 days for acute pain and 7 days for post-operative pain. This study aimed to identify patient, prescriber, and facility characteristics associated with STOP Act adherence for patients with acute or post-surgical musculoskeletal (MSK) conditions.

Design: A three-level hierarchical logistic regression model was used to predict odds of adherence with STOP Act duration limits, accounting for fixed and random effects at the patient, prescriber, and facility levels.

Setting: A large healthcare system in North Carolina.

Patients and participants: Patients (N = 6,849) presenting from 2018 to 2020 with a diagnosis of an acute MSK injury.

Interventions: The STOP Act limited the duration of opioid prescriptions in North Carolina.

Main outcome measure: Prescriptions adhering to the STOP Act duration limits of 5 days (nonoperative) or 7 days (operative) were the primary outcome.

Results: Opioids were compliant with STOP Act duration limits in 69.3 percent of encounters, with 33 percent of variation accounted for by clinician and 29 percent by facility. Patients prescribed >1 opioid (odds ratio (OR) 0.46, 95 percent confidence interval (CI): 0.36, 0.58) had reduced odds of a compliant prescription; surgical patients had increased odds of a compliant prescription (outpatient surgery: OR 5.89, 95 percent CI: 2.43-14.29; inpatient surgery: OR 7.71, 95 percent CI: 3.04-19.56). Primary care sports medicine clinicians adhered to legislation less frequently than orthopedic surgeons (OR 0.38, 95 percent CI: 0.15, 0.97).

Conclusions: Most prescriptions adhered to STOP Act legislation. Tailored interventions to improve adherence among targeted groups of prescribers, eg, those treating nonoperative injuries and sport medicine clinicians, could be useful.

 

Author Biographies

Meghan K. Wally, PhD

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute; Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina

Michael E. Thompson, DrPH

Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina

Susan Odum, PhD

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute; Department of Public Health Sciences, University of North Carolina at Charlotte; OrthoCarolina Research Institute Charlotte, Charlotte, North Carolina

Donna M. Kazemi, PhD

College of Health and Human Services, School of Nursing, University of North Carolina at Charlotte, Charlotte, North Carolina

Joseph R. Hsu, MD

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina

Michael Beuhler, MD

Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina

Michael Bosse, MD

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina

Manuel Castro, MD

Department of Psychiatry, Atrium Health, Charlotte, North Carolina

Michael Gibbs, MD

Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina

Christopher Griggs, MD

Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina

Steven Jarrett, PharmD

Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina

Daniel Leas, MD

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute; Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina

James Rachal, MD

Department of Psychiatry, Atrium Health, Charlotte, North Carolina

Tamar Roomian, MS, MPH

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina

Michael Runyon, MD

Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina

Animita Saha, MD

Department of Internal Medicine, Atrium Health, Charlotte, North Carolina

Brad Watling, MD

GIV Hydration, Huntersville, North Carolina

Ziqing Yu, MS

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina

Rachel B. Seymour, PhD

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina

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Published

10/18/2023

How to Cite

Wally, M. K., M. E. Thompson, S. Odum, D. M. Kazemi, J. R. Hsu, M. Beuhler, M. Bosse, M. Castro, M. Gibbs, C. Griggs, S. Jarrett, D. Leas, J. Rachal, T. Roomian, M. Runyon, A. Saha, B. Watling, Z. Yu, and R. B. Seymour. “Adherence to Legislation Limiting Opioid Prescription Duration Following Musculoskeletal Injury”. Journal of Opioid Management, vol. 19, no. 7, Oct. 2023, pp. 103-15, doi:10.5055/jom.2023.0804.