Reducing opioid prescriptions does not increase rate of refills or new opioid requests: evidence from a randomized trial

Introduction: Physician overprescribing of opioids contributes to chronic opioid use, overdose risk, and the accumulation of unused opioids in the community. While many interventions seek to reduce initial post-operative opioid prescriptions, concerns remain that doing so may lead to increased refill or new prescription requests, and result in inadequate pain management. Methods: We conducted a three-arm cluster-randomized trial involving 640 surgeons across three surgical specialties in 19 hospitals to evaluate the impact of guideline-based prescribing interventions. In this secondary analysis, we examined whether exposure to the intervention led to no increase in refills within six months, measured by relative risk ratio, which incorporated survival analysis to estimate the hazard ratio of treatment effect compared between intervention and post-intervention periods compared with pre-intervention. Results: Our findings show that reducing opioid amounts at discharge in the intervention arms did not significantly increase refill or new prescription fills, either overall, within specific surgical specialties, or among patients whose initial prescriptions exceeded recommended guideline quantities. Conclusion: These results support that guideline-based prescribing interventions can safely reduce opioid exposure without compromising patient pain-control and highlight important policy implications for surgical opioid stewardship.