Policy changes help reduce opioid prescriptions at Kellogg Eye Center cornea clinic

A new study in JAMA Ophthalmology details plans by University of Michigan Kellogg Eye Center to help curb the nation's opioid epidemic – starting at their own clinic.

The approach: Doctors in the cornea clinic would give patients fewer pills after surgery – the time when many people are first introduced to opioid medications. They would also talk to patients about the proper use of opioids and the associated risks.

The interventions showed the number of tablets could be decreased without compromising pain control, according to findings embargoed for release at 11 a.m., ET., Oct. 31.

Most patients had unused tablets after undergoing ophthalmic surgery on the cornea which has more nerve endings than any other part of the body.

Two recent policy changes – one by our institution, and one by our state – combined to create this new opportunity to learn about post-operative opioid consumption. First the cornea division at Kellogg changed policy, decreasing the number of opioid tablets we prescribe. Second, the state of Michigan instituted a mandatory prescription monitoring program."

Maria Woodward, M.D.,  study author and cornea chief at Kellogg Eye Center and health services researcher at the U-M Institute for Healthcare Policy and Innovation

The study team identified 82 patients who underwent cornea surgery and surveyed them post-surgery about how many pills they actually used, what pain they experienced after surgery, and what they did with any leftover pills.

Before the policy change, the average prescription for cornea surgery was 18.8 pills. When researchers interviewed patients, the amount of opioid medication they'd actually taken after the operation was 8.

The rest was often still left at home, or carried around with them.

After the policy change, the average prescription for cornea surgery dropped to 6.6 pills and patients reported using just four.

Within the group receiving the lower pill count, 84 percent of patients reported that the prescription was adequate to control their moderate to severe pain and 22 percent reported receiving more pills than they needed. Only 7 percent felt they received less medication than needed for pain control.

"We were very encouraged to see that even a dramatic reduction in the number of opioid pills prescribed had no negative impact on pain control," says Woodward, who is also an assistant professor of Ophthalmology and Visual Sciences at the University of Michigan.

The study reveals there's more work to be done to keep leftover surgery opioids out of harm's way. In the study, none of the patients discarded of pills as recommended by taking them to a health center or police station for disposal.

"This study shows we're making progress in the battle against opioid misuse," Woodward says. "But we can do more to make sure that everyone knows how to prescribe them, use them and dispose of them safely."

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