This study examined opioid prescribing practices of surgeons at Boston Medical Center and patients' experiences after elective ambulatory surgery. The researchers found that patients took on average only 42% of the opioids prescribed, with most taking 15 pills or less of the average 33 pills prescribed. Over 70% of patients had leftover opioids, and over half planned to retain unused medications rather than safely disposing of them. The findings suggest surgeons may overprescribe opioids following ambulatory surgery, contributing to potential diversion or misuse of unused pills. Improved prescribing guidelines and disposal options are needed to reduce unnecessary opioids.

1. Opioid Use After Ambulatory Surgery: Mismatch Between Prescribed and Used
Christopher Shanahan MD MPH, 1 Inga Holmdahl BA, 1 Olivia Gamble BA, 1 Julia Keosaian MPH,1
Marc LaRochelle MD MPH, 1 Ziming Xuan ScD, 2 Jane Liebschutz MD MPH1
1Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center;
2Department of Community Health Sciences, Boston University School of Public Health
ABSTRACT
• Overprescribing of opioids may contribute to diversion and addiction
• Evidence shows that patients undergoing elective day-surgery may receive more opioids than
necessary for post-operative pain management. 2,3,4
• We characterized surgeons’ post-operative opioid analgesia prescribing practices & patient
experiences through a prospective study of patients undergoing elective ambulatory surgery.
METHODS
Study Design:
• Prospective observational study
• 18 different surgeons at BMC referred their patients for the study
Recruitment:
• Participants screened & enrolled in-person at pre-operative appointments or via phone
Inclusion Criteria:
• ≥18 years
• Undergoing elective ambulatory surgery (Orthopedic, otolaryngology, general, podiatry,
maxillofacial, gynecology, and urology)
Data Collection:
• Patients surveyed in person or via phone week prior to & 7-10 days after planned surgery
• Electronic Health Record used to confirm surgery date & type as well as opioid prescription
information
Demographics
• 181 enrolled; complete follow-up data obtained from 149
participants (83% retention)
• 53% female; mean age: 49 years
RESULTS
Figure 1: Participant Flow Diagram

2. RESULTS (CONTINUED)
Post-operative usage, refills, and storage:
• Participants reported taking 42% of the pills prescribed over the 10-day post-
operative period (average 15 pills each)
• 71% (94) of participants reported having leftover pills
• 14% (18) of participants reported taking pills more often than prescribed
• 10% (13) of participants reported seeking an early refill.
CONCLUSIONS
REFERENCES
• Most participants reported using substantially less post-operative opioid pain
medication than prescribed.
• Over half of participants reported plans to retain unused medications after pain
resolution.
• To reduce unnecessary opioid prescribing and potential availability for diversion
and misuse, improved prescribing practices and disposal options are needed.
• Future studies may include an academic detailing component to review physician
prescribing practices, provide individualized feedback support to help improve
practices, pre-operative pain management patient counseling and provide patient
support in initiating safe opioid use and disposal.
1. Bates C, et.al. Overprescription of Postoperative Narcotics: A Look at Postoperative Pain Medication Delivery, Consumption and Disposal in Urological Practice. J. Urology. 2011;185(2):551-5.
2. Rodgers J, et.al. Opioid Consumption Following Outpatient Upper Extremity Surgery. J. Hand Surgery. 2012;37(4):645-50.
3. Mutlu I, et.al. Narcotic Prescribing Habits and Other Methods of Pain Control by Oral and Maxillofacial Surgeons After Impacted Third Molar Removal. J. Oral and Maxillofacial Surgery. 2013;71(9):1500-3.
33%
33%
15%
6%
5%
8%
Safe disposal (police, flushing)
Keep them
Keep taking them
Throw away
Did not know plans
Other
Figure 3: Plan for Leftover Medication at Follow-Up
Opioid Prescription
• 95% of participants prescribed opioid medications for post-operative analgesia
• Surgeons prescribed an average of 33 pills per participant
Figure 2: Pills Taken In Post-Operative Period (n=133)
13%
29%
46%
12%
0%
10%
20%
30%
40%
50%
0 1-7 8-32 33-67
%ofParticipants
TakingOpioids
Tablets
Opioid Use After Ambulatory Surgery: Mismatch Between Prescribed and Used
Christopher Shanahan MD MPH, 1 Inga Holmdahl BA, 1 Olivia Gamble BA, 1 Julia Keosaian MPH,1
Marc LaRochelle MD MPH, 1 Ziming Xuan ScD, 2 Jane Liebschutz MD MPH1
1Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center;
2Department of Community Health Sciences, Boston University School of Public Health
(n=113)
Supported by a grant from the
CareFusion Foundation