Effects of Opioid-Limiting Legislation in the State of Ohio on Opioid Prescriptions After Shoulder Arthroscopy

John T Strony; Yazdan Raji; Nikunj N Trivedi; Christopher J McMellen; Jiao Yu; Jacob G Calcei; James E Voos; Robert J Gillespie

doi:10.1177/23259671231202242

Effects of Opioid-Limiting Legislation in the State of Ohio on Opioid Prescriptions After Shoulder Arthroscopy

Orthop J Sports Med. 2023 Nov 20;11(11):23259671231202242. doi: 10.1177/23259671231202242. eCollection 2023 Nov.

Authors

John T Strony^{1

2}, Yazdan Raji^{1

2}, Nikunj N Trivedi^{1

2}, Christopher J McMellen^{1

2}, Jiao Yu³, Jacob G Calcei^{1

2}, James E Voos^{1

2}, Robert J Gillespie^{1

2}

Affiliations

¹ University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
² Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
³ University of Minnesota, Minneapolis, Minnesota, USA.

Abstract

Background: Recent studies have shown that legislation regulating opioid prescriptions in the United States has been successful in reducing the morphine milligram equivalent (MME) prescribed after certain orthopaedic procedures.

Purpose: To (1) determine the effect of Ohio's legislation limiting opioid prescriptions after shoulder arthroscopy and (2) identify risk factors associated with prolonged opioid use and increased postoperative opioid dosing.

Study design: Cohort study; Level of evidence, 3.

Methods: We reviewed the data of patients who underwent shoulder arthroscopy between January 1, 2016, and March 31, 2020. Patients were classified according to the date of legislation passage (August 31, 2017) as before legislation (PRE) or on/after legislation (POST). Patients were also classified based on the number of opioid prescriptions filled within 30 days of surgery as opioid-tolerant (at least 1 prescription) or opioid-naïve (zero prescriptions). We recorded patient characteristics, medical comorbidities, and surgical details, as well as the number of opioid prescriptions, MME per prescription from 30 days preoperatively to 90 days postoperatively, and the number of gamma-aminobutyric acid (GABA) analogues and benzodiazepine prescriptions from 30 days preoperatively to the date of surgery. Differences between cohorts were compared with the Fisher exact test and Wilcoxon test. A covariate-adjusted regression analysis was used to evaluate risk factors associated with increased postoperative opioid dosing.

Results: Overall, 279 patients (n = 97 PRE; n = 182 POST; n = 42 opioid-tolerant; n = 237 opioid-naïve) were included in the final analysis. There was a significant reduction in the cumulative MME prescribed in the immediate (0-7 days) postoperative period (PRE, 450 MME vs POST, 315 MME), the first 30 postoperative days (PRE, 590 MME vs POST, 375 MME), and the first 90 postoperative days (PRE, 600 MME vs POST, 420 MME) (P < .001 for all). The opioid-tolerant cohort had higher MME at every time point in the postoperative period (P < .001). Consumption of preoperative opioid (β = 1682.5; P < .001), benzodiazepine (β = 468.09; P < .001), and GABA analogue (β = 251.37; P = .04) was associated with an increase in the cumulative MME prescribed.

Conclusion: Opioid prescription-limiting legislation in Ohio significantly reduced the cumulative MME prescribed in the first 30 days postoperatively for both opioid-naïve and opioid-tolerant patients after shoulder arthroscopy. Consumption of opioids, benzodiazepines, and GABA analogues preoperatively was associated with increased postoperative opioid dosage.

Keywords: legislation; monitoring; opioids; postoperative; risk factors; shoulder arthroscopy.