Within five months of the new guidelines taking effect at Michigan Medicine, surgeons reduced the volume of prescribed opioids by about 7,000 pills. It's now been a year since the change took effect, and the researchers estimate they have curbed prescriptions by about 15,000 pills, said Ryan Howard, a general surgery resident and the paper's lead author.
That has real implications. Studies have found that overprescribing opioids helps drive the epidemic. It can put patients at risk of addiction. And it endangers friends and family, who can easily acquire unused excess pills in, for instance, an unsecured medication cabinet. Reducing prescriptions altogether makes that less likely.
"This really shows in a very methodological way that we are dramatically overprescribing," said Michael Botticelli, who spearheaded drug-control policy under the Obama White House, including the administration's response to the opioid crisis.
"Not only do we have to reduce the supply to prevent future addiction, but we really have to minimize opportunities for diversion and misuse," he said.
More hospitals are starting to turn in this direction, Botticelli said. He now runs the Grayken Center for Addiction at Boston Medical Center, which is also trying to systematically reduce opioid prescriptions after patients have surgery.
Meanwhile, 24 states have passed laws to limit how many pills a doctor can prescribe at once, according to the National Conference of State Legislatures.
"Those limits are just sort of generic limits across the board," said Chad Brummett, an anesthesiology professor at the University of Michigan and another co-author of the paper. Their concept, he added, "is a step even further beyond what some of these policymakers are trying to do, and it's one I think surgeons are more likely to adopt."
The researchers also created a set of talking points for doctors and nurses to use with patients based on "fairly common sense" measures, Lee said. They include:
-- Encouraging patients to use lower-strength, non-addictive painkillers first
-- Warning them about the risks of addiction