Opioid Prescription After Carpal Tunnel Release Is Declining Independent of State Laws

Abstract

Background: The opioid misuse crisis focused attention on opioid overprescribing prompting legislation, limiting prescribing. The purpose of this study was to evaluate of opioid filling surrounding carpal tunnel release (CTR) with the hypothesis that filling has decreased in response to state legislation.

Methods: This is a retrospective, observational study of initial discharge, 30-day, 90-day, and 1-year cumulative opioid filling after CTR in a commercial insurance database between 2010 and 2018. All patients aged 18 and older undergoing CTR and with active insurance status for 6 months preoperative through 30 days, 90 days, and 1 year postoperative were considered for inclusion. Patients undergoing same-day distal radius fracture fixation were excluded. Initial and cumulative perioperative patient, state, and year-level opioid filling rates and volumes in oxycodone 5 mg equivalents (oxycodone 5-mg pills) were evaluated.

Results: Patients filled mean volumes of 33, 72, and 144 oxycodone 5-mg pills in the initial prescription, by 90 days post-op and by 1 year post-op, respectively. First prescription opioid filling volume (35 oxycodone 5-mg pills 2010 and 27 oxycodone 5-mg pills 2018, P < 0.001) and cumulative 90-day filling (96 oxycodone 5-mg pills 2010 and 56 oxycodone 5-mg pills 2018, P < 0.001) have decreased significantly from 2010 to 2018. Ten of 24 (41.7%) of states with opioid-limiting legislation had large (>5 oxycodone 5-mg pills), significant reductions in initial opioid filling volume after legislation. Five of 13 (38.5%) states without opioid-limiting legislation had similar reductions during the study period. Thirteen of 24 (54.2%) states with opioid-limiting legislation had large, notable reductions in 90-day opioid filling volume after legislation. Six of 13 (46.2%) states without opioid-limiting legislation had similar reductions during the study period.

Conclusion: Initial and cumulative opioid filling surrounding CTR has decreased significantly since 2010. However, opioid legislation did not result in substantial changes in rates of large, significant reductions in state-specific opioid prescribing.