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Post-Surgical Prescribing Protocol for Cancer Patients Cuts Chronic Opioid Use
Instituting a 3-day limit on opioid prescriptions to treat surgical pain after discharge reduced the number of patients who became chronic opioid users without compromising pain relief or recovery, according to a recent study conducted by researchers at Roswell Park Comprehensive Cancer Center in Buffalo, New York.
Findings from the study were published in JAMA Oncology.
New York state has a 7-day prescribing limit for opioids, but the 7-day limit does not apply for treating acute pain in cancer patients.
From February to July 2019, Roswell Park implemented a quality improvement protocol that affected 2051 surgical patients. During the period, providers were advised to prescribe no more than a 3-day supply of opioid pain medications after surgery. Individual surgical service providers were tasked with creating their own algorithms that were both compliant with the protocol and able to control pain.
In the 6 months prior to the implementation of the protocol, 2017 patients were prescribed opioids for an average duration of 3.9 days. During the protocol, that figure dropped to 1.9 days—a 45% reduction. Requests for refills by patients also declined, from 20.9% to 17.9%. Further, chronic opioid use decreased among opioid-naïve cancer patients from 11.3% to 4.5% and non-cancer patients (6.1% to 2.7%).
The Roswell Park Pharmacy Department reported 95% prescriber compliance with the protocol, which has since been adopted as the center’s standard of care.
In a news release announcing the findings, Emese Zsiros, MD, PhD, the Shashi Lele, MD, endowed chairperson and director of research in Roswell Park’s Department of Gynecologic Oncology, said she hopes the study’s findings spark changes in post-surgical pain management.
“Implementing a restrictive protocol across a cancer center is not only feasible,” Dr Zsiros said, “but decreases the circulating opioids in the community and the conversion to chronic opioid use among our cancer patients.”
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