Impact of Florida State Law on Opioid Prescriptions After Cesarean Delivery

Paul P Potnuru, Selina D Patel, David J Birnbach, Richard H Epstein, Roman Dudaryk

Summary

Implementation of the Florida law House Bill 21 (HB 21) limiting opioids prescribed after surgery was associated with a lower total dose and shorter duration of opioid prescriptions after hospital discharge following cesarean delivery without the need for additional opioids or emergency department visits in the early puerperium period.

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Author Comments

Dr Paul Potnuru, MD
Dr Paul Potnuru, MD
McGovern Medical School, University of Texas Health Science Center at Houston
Assistant Professor
Clinical Informatics
Houston, TX | United States
The effects of this law on opioid prescriptions for cesarean delivery patients are interesting when contrasted with the effects in general surgery patients. The proportion of patients receiving opioids on discharge remained the same after passage of the law in cesarean delivery patients (but not in general surgery patients). There was however lower total doses of opioids prescribed and shorter duration of prescriptions. The methodology used in this study (segmented regression analysis of an interrupted time series) is a powerful technique to analyze the impact of public health interventions, controlling for pre-existing trends.Dr Paul Potnuru, MD

Effects of State Law Limiting Postoperative Opioid Prescription in Patients After Cesarean Delivery.

Authors:
Dr Paul Potnuru, MD
Dr Paul Potnuru, MD
McGovern Medical School, University of Texas Health Science Center at Houston
Assistant Professor
Clinical Informatics
Houston, TX | United States

Anesth Analg 2020 Jun 25. Epub 2020 Jun 25.

Department of Anesthesiology and Perioperative Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida.

Background: The impact of the Florida State law House Bill 21 (HB 21) restricting the duration of opioid prescriptions for acute pain in patients after cesarean delivery is unknown. Our objective was to assess the association of the passage of Florida State law HB 21 with trends in discharge opioid prescription practices following cesarean delivery, necessity for additional opioid prescriptions, and emergency department visits at a large tertiary care center.

Methods: This was a retrospective cohort study conducted at a large, public hospital. The 2 cohorts represented the period before and after implementation of the law. Using a confounder-adjusted segmented regression analysis of an interrupted time series, we evaluated the association between HB 21 and trends in the proportions of patients receiving opioids on discharge, duration of opioid prescriptions, total opioid dose prescribed, and daily opioid dose prescribed. We also compared the need for additional opioid prescriptions within 30 days of discharge and the prevalence of emergency department visits within 7 days after discharge.

Results: Eight months after implementation of HB 21, the mean duration of opioid prescriptions decreased by 2.9 days (95% confidence interval [CI], 5.2-0.5) and the mean total opioid dose decreased by 20.1 morphine milligram equivalents (MME; 95% CI, 4-36.3). However, there was no change in the proportion of patients receiving discharge opioids (95% CI of difference, -0.1 to 0.16) or in the mean daily opioid dose (mean difference, 5.3 MME; 95% CI, -13 to 2.4). After implementation of the law, there were no changes in the proportion of patients who required additional opioid prescriptions (2.1% vs 2.3%; 95% CI of difference, -1.2 to 1.5) or in the prevalence of emergency department visits (2.4% vs 2.2%; 95% CI of difference, -1.6 to 1.1).

Conclusions: Implementation of Florida Law HB 21 was associated with a lower total prescribed opioid dose and a shorter duration of therapy at the time of hospital discharge following cesarean delivery. These reductions were not associated with the need for additional opioid prescriptions or emergency department visits.

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Source
http://dx.doi.org/10.1213/ANE.0000000000004993DOI Listing
June 2020
3.472 Impact Factor

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