Effects of a Prescription Drug Monitoring Program on Opioid Prescriptions Following Total Joint Arthroplasty in the State of California

Abstract

In an attempt to reduce opioid prescriptions, the state of California mandated physician participation in the Controlled Substance Utilization Review and Evaluation System (CURES). The goal of this study is to assess whether this intervention led to a change in prescribing habits after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). The 90-day postoperative narcotic use was retrospectively reviewed for 13,382 patients undergoing primary THA and TKA. Patients were divided into pre-CURES and post-CURES cohorts based on date of surgery. Narcotic use was measured in morphine milligram equivalents (MME). There was a 21.3% decrease in postoperative MME post-CURES for patients undergoing THA (756.5±759.5 MME vs 962.00±864.4 MME, P <.0001) and a 19.9% decrease in postoperative MME post-CURES for patients undergoing TKA (1274.3±2707.1 MME vs 1590.6±1725.3 MME, P <.0001). Patients post-CURES required an additional prescription at 2 weeks more frequently compared with patients pre-CURES after THA (27.5% vs 20.5%, P <.001) and TKA (54.2% vs 44.2%, P <.001). Patients undergoing THA had 40.5% and 40.6% less narcotic prescribed compared with patients undergoing TKA pre-CURES and post-CURES ( P <.001), respectively. Government guidelines led to a substantial decrease in postoperative MME prescribed after TKA and THA. Patients undergoing THA had a substantially smaller amount of narcotic prescribed than patients undergoing TKA. [ Orthopedics . 2023;46(2):70–75.]