Habbouche J, et al. - Researchers investigated if an association exists between the October 2014 US Drug Enforcement Administration change for hydrocodone-containing medications from schedule III to II and the amount of opioid filled following surgery. They analyzed claim data of 21 955 privately insured surgery patients in Michigan, revealing an immediate significant increase following the schedule change in the amount of opioids filled in the initial postoperative prescription, which was sustained for 1 year. They recommend performing a close follow-up of opioid-related policies to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors.

Methods

• The trends in the amount of postoperative opioids filled before and after the schedule change were examined via performing an interrupted time series analysis of outpatient opioid prescriptions.
• Insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan, were used to analyze opioid prescriptions filled between January 2012 and October 2015.
• Researchers included 21,955 adult inpatients (18 to 64 years of age) who underwent 1 of 19 common elective surgical procedures and filled an opioid prescription within 14 days of discharge to home.
• For this study, the primary outcome assessed was the trends in the mean amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of October 6, 2014, compared using interrupted time series and multivariable regression analyses.
• The total amount of opioids filled and the refill rate for the 30-day postoperative period were assessed as the secondary outcomes.
• They performed subgroup analyses by hydrocodone prescriptions, nonhydrocodone prescriptions, surgical procedure, and prior opioid use.

Results

• Researchers performed an analysis of data from 21,955 patients undergoing surgical procedures across 75 hospitals and 5120 prescribers.
• With respect to sex (10,197 of 15,791 [64.6%] vs 3966 of 6169 [64.3%] female; P=.69) and mean (SE) age (47.9 [11.2] vs 47.7 [11.3] years; P=.19), cohorts before and after the schedule change were similar .
• They noted an increase in the mean OMEs filled in the initial opioid prescription by approximately 35 OMEs (β = 35.1 [13.2]; P < .01), equivalent to 7 tablets of hydrocodone (5 mg), after the schedule change.
• During the 30-day postoperative period before and after the schedule change, they noted no significant differences in the total OMEs filled (β = 18.3 [30.5]; P=.55), but there was a significant decrease in the refill rate (β = −5.2% [1.3%]; P < .001).