Michigan Value Partnerships and the Institute for Healthcare Policy
and Innovation at University of Michigan. Michigan OPEN's goal is to
standardize post-op and acute care opioid prescribing.
The research group rose out of a desire to cover up a blind spot in
the CDC's 2016 opioid prescription guidelines, which were released in
response to the epidemic of overdose deaths. "I'm a big fan of the
guidelines, but they're really about chronic pain and chronic pain
management," says Dr. Brummett. "They have one line for acute pain
that simply says to prescribe for the lowest amount possible for the
shortest time possible. While I agree with that recommendation, it
doesn't necessarily direct surgeons on how to prescribe."
Michigan OPEN has released evidence-based opioid prescription
guidelines for 25 surgeries, and is in the process of adding more (see
"Proven Prescribing Recommendations").
Awareness of the need to right-size opioid prescriptions is growing
among surgeons, OR staff, facility leaders and patients, and not a
moment too soon. "Becoming a new persistent opioid user is one of
the most common complications after elective surgery, and yet it's
something we hadn't previously thought about or talked about with
patients," says Dr. Brummett.
His team reported in 2017 that roughly 6% of surgical patients who pre-
sented as opioid-naïve became new persistent users. The research cov-
ered both outpatient and inpatient surgeries and, interestingly, the intensi-
ty of the procedure didn't matter; the percentage stayed about the same.
An important reason for standardizing opioid prescriptions is to elimi-
nate confusion and even subconscious behavior by patients. "There's
some psychology behind it, in terms of, 'If we give you more, you're going
to take more,'" says Charles Hannon, MD, a resident physician in the
department of orthopedic surgery at Rush University Medical Center in
Chicago, Ill. Dr. Hannon says Rush's clinical trials found that hip and knee
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