Michigan outperforms national trends in reducing opioid prescribing after surgery

Opioid addiction is the top complication after elective surgery for patients who have never taken them before and aren’t familiar with the risks. But thanks to a statewide effort to develop and disseminate opioid prescribing guidelines, cosponsored by Blue Cross Blue Shield of Michigan, the levels of opioids prescribed after surgery are dropping significantly in Michigan compared to other states.

According to a study published in Annals of Surgery,* Michigan’s prescription guidelines led to a 56% reduction in the amount of opioids patients received after surgery, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased.

The Michigan Opioid Prescribing Engagement Network* and the Michigan Surgical Quality Collaborative,* both part of Blue Cross Blue Shield of Michigan’s Value Partnerships program, developed the prescribing guidelines.

“This work is critical as opioid addiction is the No. 1 complication for previously opioid-naïve patients having elective surgery,” said Faris Ahmad, M.D., medical director at Blue Cross. “By reducing the prescribing of opioids for post-surgical patients, it also reduces the number of unused opioids lying around in people’s medicine cabinets.”

To develop the prescribing guidelines,* clinicians and researchers used data collected from several CQI clinical registries, including our general surgery, urology, knee and hip replacement surgery, and cardiothoracic surgery CQI registries. These registries provide data on hundreds of thousands of procedures performed at surgical facilities across the state.

Using the data from the general surgery CQI, they were able to develop recommendations on how many opioids to prescribe following six general surgical procedures:

• Minimally invasive gallbladder removal
• Appendix removal
• Minor hernia repair
• Major hernia repair
• Removal of part of the colon (colectomy)
• Hysterectomy

Researchers analyzed prescribing patterns in the four years preceding the guidelines and for two years afterward. In just under two years:

• There was a 56% reduction in the amount of opioids patients received after having any of the six general surgical operations, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased. Both of those drops beat national trends for similar patients.
• The average number of pills prescribed per case dropped by an additional 11 pills/case when compared to the reductions seen in other states.

“Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said Chad Brummett, M.D., co-director of Michigan OPEN. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”

The study focuses on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who had one of these procedures. Prescribing guidelines were implemented in 70 hospitals across Michigan.

Michigan OPEN works with Michigan Medicine, Blue Cross and the Michigan Department of Health & Human Services.

*Blue Cross Blue Shield of Michigan doesn’t own or control this website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.