Study Finds Significant Reductions in Long-Term Opioid Prescriptions in the U.S.

Using a dataset that includes civilians and military personnel, researchers from Mass General Brigham found a growing trend of patients receiving shorter opioid prescriptions following surgical procedures

The opioid crisis remains a major global health issue, with numerous initiatives implemented over the past decade aimed at addressing it through opioid prescription regulations, provider education, and other risk mitigation strategies. While these strategies have been implemented, their impact hasn’t been properly measured and may vary by population. To address this gap, researchers from Mass General Brigham compared changes in long-term opioid use among people on the TRICARE health plan, which covers military personnel and their families, following surgery in the U.S. from 2017 to 2022. They found a significant reduction in the number of patients being prescribed opioids long-term, which could be indicative of a national trend. Results are published in Lancet Regional Health.

“It’s currently estimated that more than 1.5 million people in the U.S. receive treatment annually for opioid use disorder, and about 68% of all drug overdoses involve opioids. To address this issue, it is crucial to evaluate the effectiveness of prior efforts aimed at reducing access to opioid prescriptions,” said corresponding author Andrew Schoenfeld, MD, of the Center for Surgery and Public Health and the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “Our study represents one of the largest and most comprehensive assessments of opioid use following surgery, providing a significant indication of how effective these efforts have been.”

Schoenfeld and his colleagues used TRICARE claims data, a Military Health System (MHS) insurance product covering civilians and military personnel nationwide, to identify those who have undergone one of 14 surgical procedures included in the study. The study population of 410,227 people included active-duty members and civilian dependents, retirees, and medically discharged individuals with 30% disability or greater. They then compared the rate of long-term post-operative prescription opioid use, determined by six months of continuous use, from 2020 to 2022 with that from 2017 to 2019. They incorporated secondary analyses to consider the interactions among time periods, race, pre-operative opioid usage, care settings, and socioeconomic factors. The results showed a significant reduction in long-term opioid prescriptions, dropping from 11% of patients (21,556) in the period up to 2019 to 6% of patients (12,114) in the period from 2020 to 2022.

Although statistically significant, claims data do not provide insights into the reasons behind surgeries, the justifications for prolonged prescriptions, monitoring patients who left the MHS, or other aspects of patients' prescription behavior. According to the researchers, this study is likely reflective of national trends due to the large cross-section of patient demographics found to be representative of the general U.S. population, aged 18 to 64. However, the authors also recommend that future studies explore if there are any strategies that have been implemented by the MHS that could help lower opioid usage if implemented across the civilian health system.

“A great deal of care is delivered in the private sector, and given the nature of the dataset, we were able to look at care delivered across the U.S. in a variety of different settings, including department of defense facilities as well as private sector,” said Schoenfeld. “As a result, we believe the findings are reflective of generalizable trends.”

Authorship: In addition to Schoenfeld, Mass General Brigham authors include Zara Cooper, Jonathan Gong, and Matthew Bryan.

Funding: U.S. Department of Defense, Defense Health Agency (award # HU00012120089)

Paper cited: Schoenfeld, Andrew et al. “Long-Term Prescription Opioid Use Following Surgery in the US (2017-2022): A population-based study” Lancet Regional Health DOI: 10.1016/j.lana.2024.100948