Taking the pain out of surgery by reducing opioid prescribing

Published February 5, 2019

Persistent use of opioids is one of the most common complications after elective surgery, and oftentimes surgery patients are sent home with far more painkillers than they actually take. Over-prescribing of opioids continues to be a contributing factor to our country’s opioid epidemic and can lead to addiction and overdose.  

In Michigan, overdose deaths from opioids hit a record high last year, moving a surgeon-led team at Michigan Opioid Prescribing Engagement Network (OPEN) to convene hospitals, health insurers and surgeons to develop new guidelines to reduce unnecessary opioid prescribing and curb overdose deaths.

Michigan OPEN launched in 2016, with support from Blue Cross Blue Shield of Michigan (BCBS Michigan), the Michigan Department of Health and Human Services, and the Institute for Healthcare Policy and Innovation at the University of Michigan. Since then, the team has published research that shows fewer opioids can still effectively manage patients’ pain following surgery. 

“We realized that we could drastically cut down on opioid prescriptions without increasing our patients’ pain,” says Dr. Michael Englesbe, who is the co-director of Michigan OPEN and the Cyrenus G. Darling Sr., M.D. and Cyrenus G. Darling Jr., M.D. Professor of Surgery at the University of Michigan in the section of transplantation surgery. “By prescribing fewer opioids following surgery, we not only reduce the risk of opioid use disorder for that patient, but we also reduce the amount of unused medications in homes that pose a potential threat to family members.”

By analyzing the maximum number of opioids used by surgery patients, Michigan OPEN recently developed prescribing guidelines for 16 common operations, ranging from breast cancer surgery to hernia repair. Each procedure comes with a recommended number of prescription pain pills. 

Additionally, the guidelines include counseling recommendations that cover various topics such as the level of pain patients can expect to experience, appropriate use of opioids, adverse effects and proper disposal of pain medications.

But developing the guidelines was only half the battle. 

“In order for the guidelines to be effective in reducing opioid prescriptions, we had to be sure that surgeons would actually use them,” says Dr. Englesbe. 

To increase adoption of the prescribing guidelines for surgery, Michigan OPEN partnered with BCBS Michigan, who connected them with 11 of the physician-led networks it funds called Collaborative Quality Initiatives (CQIs). The funding allows the doctors and hospitals that are part of CQIs to collaborate and share information across the network to improve care and enhance the health of residents throughout the state. 

“Many of the CQIs Blue Cross Blue Shield of Michigan fund are already deeply committed to addressing the opioid epidemic in our state,” says Dr. Thomas Simmer, BCBS Michigan’s chief medical officer.

“Our partnership has the potential to connect the Michigan OPEN team and its prescribing guidelines with motivated doctors and hospitals all over Michigan to transform statewide practices, drastically reducing unnecessary opioid use.” – Dr. Thomas Simmer, chief medical officer at BCBS Michigan

BCBS Michigan also recognized that implementing the guidelines and counseling patients on safe opioid use would require more of the surgeons’ time.  

“Surgeons play a key role in the health of our communities, and their time is valuable. That is why we reimburse them for the extra time they spend with each patient to ensure patients get the recommended opioid prescription that is right for them and understand the potential risks of opioid use,” says Dr. Simmer.

While the prescribing guidelines for surgery are still relatively new, there has already been a reduction in opioid prescriptions. The Michigan OPEN and BCBS Michigan teams are currently analyzing data to determine the impact the guidelines are having on opioid prescribing and overall health.  

Blue Cross Blue Shield of Michigan is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.