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ASBrS 2019: Opioid Management Program Reduces Post–Breast Surgery Narcotic Use

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Key Points

  • Planned modification of prescribing patterns resulted in a statistically significant reduction in the number of pills given to patients for excisional biopsy/lumpectomy, with 10 pills prescribed, and mastectomy with reconstruction, with 25 pills prescribed. 
  • The median medication taken by patients was significantly less than prescribed. 
  • 40% of patients reported using no prescribed opiates.

A breast surgery opioid prescription management program that analyzed current physician patterns and provided education and guidelines successfully reduced the volume of narcotics given postoperatively to patients at a large institution. These results were presented by Fan et al at the Annual Meeting of the American Society of Breast Surgeons (ASBrS).

In the study, a baseline review of medication practices found lack of a clear standard for opioid prescriptions, with highly significant variation across individual surgeons. Following a review with physicians about the median and range numbers of pills given for pain, opioids prescribed to patients for home use decreased significantly. A survey of patients revealed that they took even fewer pills than prescribed with a subgroup that took none at all.

“Prescribed narcotics add to today’s crisis,” said study author Stephanie Valente, DO, FACS, of the Cleveland Clinic. “Overprescribed drugs can contribute to a problem for patients. Unused pills can also make their way into the general population. As physicians, we have an obligation to ensure opioids are not prescribed unnecessarily, but that postoperative pain is appropriately controlled. This prospective quality initiative study provided our breast surgeons the information to do so.”

Establishment of Baseline and Treatments

In the study, researchers established a baseline by reviewing the opioids prescribed to 100 patients during a 1-month period in 2017. Following implementation of the surgeon education program, data was collected on new narcotic regimens. A follow-up patient survey assessed the actual number of pills patients used.

Prescribed opioids included tramadol, acetaminophen plus codeine, hydrocodone bitartrate/acetaminophen, and acetaminophen/oxycodone, and ranged from 0–40 pills. Prior to the program, the median pills number of pills given for excisional biopsy/lumpectomy was 15; for mastectomy, 20; and for mastectomy with reconstruction, 28.

Program Results

Planned modification of prescribing patterns resulted in a statistically significant reduction in the number of pills given to patients for excisional biopsy/lumpectomy, with 10 (P < .01) pills prescribed, and mastectomy with reconstruction, with 25 (P < .01) pills prescribed. The median medication taken by patients was significantly less than prescribed. Forty percent of patients reported using no prescribed opiates.

“Little information exists in the literature about appropriate opiate dosing for postoperative breast surgery pain,” said Dr. Valente. “Many surgeons draw on their medical school backgrounds. Better physician education based on patient feedback is important to help address today’s opiate crisis. Patients are concerned with opioid medications and want to take the minimum amount needed, which is lower than physicians assume.”

Dr. Valente believes that an important next step will be analyzing why some patients are able to refrain from taking any narcotic medications and whether factors other than individual pain threshold account for the differences. She noted, “Alternatives to narcotics exist for postsurgical pain. Local anesthetics, nerve blocks, anti-inflammatory and antinausea medications, and old-fashioned icing all can help. Physicians must take stewardship of opioid prescribing habits and look for alternative medications which can work just as well.”  

Disclosure:  For full disclosures of the study authors, visit breastsurgeons.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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