Could opioid prescription times turn red

Most people who get a prescription for opioid pain relievers to relieve pain from surgery or dental procedures fill it immediately. But a new study shows some are filling those prescriptions more than a month later – long after the acute pain of their care should have worn off.

In 2019, 1% of opioid prescriptions from dentists and surgeons were filled more than 30 days after writing, according to the new study in Open JAMA Network by a team from the University of Michigan. Although small, this percentage would translate to more than 260,000 opioid prescriptions per year if generalized to all surgical and opioid prescriptions in the United States.

“Our results suggest that some patients use opioids from surgeons and dentists for a reason or for a period other than that intended by the prescriber,” says lead author Kao-Ping Chua, MD, Ph.D, pediatrician at the ‘UM and Fellow of the Susan B. Meister Center for Child Health Assessment and Research (CHEAR) and the UM Institute for Healthcare Policy and Innovation. “These are two forms of prescription opioid abuse, which in turn are an important risk factor for opioid overdose.”

The study authors note that state and federal laws governing expiration times for prescriptions of controlled substances may be partly responsible.

In 2019, 18 states allowed prescriptions for Schedule II opioids and other controlled substances – those most at risk of being diverted for misuse – to be filled for up to 6 months after they were written. Eight other states have authorized dispensing of these drugs up to 1 year after prescription.

“It’s baffling that states allow controlled substance orders to be filled so long after they’re written,” Chua says. He notes that tightening state laws could be a simple way to prevent or reduce the abuse associated with late dispensing of opioids.

As evidence, the study looked at the effects of a Minnesota law that in July 2019 prohibited dispensing opioids more than 30 days after writing. After implementation, Deferred Distribution dropped rapidly compared to other states.

The authors note that a blanket rule limiting the time window for filling opioid prescriptions could inadvertently harm patients taking the chronic pain medications. Instead, they say, policymakers could implement laws that limit this time window to only when opioids are written for acute pain.

The authors also note that prescribers can reduce dispensing delays by including instructions on the prescription not to dispense opioids after a certain amount of time.

In addition to Chua, study authors include Romesh Nalliah of the UM School of Dentistry, Michael Smith of the UM School of Pharmacy, research assistant Shreya Bahl, and Jennifer Waljee and Chad Brummett, all of whom are two co-directors of the Michigan Opioid Prescribing and Engagement Network.

OPEN, as it is called, offers evidence-based opioid prescribing guidelines and educational materials for opioids for acute pain, and works to increase safe disposal options.

Citation: Estimated Prevalence of Delayed Dispensing Among Opioid Prescriptions by US Surgeons and Dentists, JAMA Netw Open. 2022;5(5):e2214311. doi:10.1001/jamanetworkopen.2022.14311

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