Evaluation of opioid prescribing for surgical patients discharged from three metropolitan hospitals between 2012 and 2020

Abstract

This multicentre, retrospective medical record audit evaluated opioid analgesia prescribing within a Victorian metropolitan public hospital network. The study included all surgical patients discharged between January 2012 and December 2020 with one or more discharge prescriptions from three metropolitan hospitals ( n = 117,989). The main outcome measures were mean oral morphine equivalent daily dose (OMEDD), mean number of opioid types and proportion of patients prescribed one or more slow-release opioids on discharge. Total opioid prescribing (mean OMEDD) peaked in 2013. Between 2017 and 2020 there was a trend towards prescribing fewer opioids on discharge. Over the study period, there was decreasing prescription of codeine and increasing prescription of oxycodone and tapentadol. The proportion of patients prescribed slow-release opioids increased in the earlier years of the study, reaching a peak of 20.6% in 2017. Since 2017 there has been a rapid reduction in the prescription of slow-release opioids. Subanalysis was undertaken to evaluate key changes in the opioid prescribing landscape in the health network. The removal of default opioid pack sizes in the electronic medication management system (December 2014) and the release of the Faculty of Pain Medicine–Australian and New Zealand College of Anaesthetists’ statement regarding the use of opioid analgesics in patients with chronic non-cancer pain (March 2018) were associated with significant reductions in mean OMEDD prescribed on discharge (136 mg vs 122 mg and 120 mg vs 85.4 mg, respectively, P < 0.001). In conclusion, the quantity of opioids prescribed on discharge in this patient group peaked in 2013 and has been decreasing since.