As recently as the early 2010s, it was standard practice for surgeons to provide 30 to 40 or more opioid pills for common, minimally invasive procedures. Most of these pills, however, would remain untouched, left over in the patient’s medical cabinet or kitchen pantries for potential misuse. A team of researchers led by URMC’s Dr. Jacob Moalem set out to reduce these opioid overprescriptions.
This project began when Moalem allowed his patients to decide whether or not to go home with an opioid prescription. The results were jarring: Of the first 216 patients, 96% chose to go home with nothing.
“So much of the apprehension about sending patients home with less or with nothing was actually my own apprehension,” Moalem expressed. “It wasn’t the patients. It was me.”
His concern wasn’t unique, as medical specialists’ views on opioid prescriptions have been shaped, in part, by decades of misinformation from the pharmaceutical industry. “A big part of how and why the opioid crisis developed was misinformation from the pharmaceutical industry,” explained Moalem, “which was spending hundreds of millions of dollars to educate the entire medical community about how non-harmful these medications were. It was very damaging.”
When Moalem and his team began analyzing their own prescribing patterns at URMC in 2020, what they found was striking. A large proportion of discharged patients reported no pain in the 48 hours prior to discharge and did not take any pain medication during that time. And yet, more than half of those patients were still being sent home with opioid prescriptions.
Their question formed intuitively: “Why would you send somebody home with pain medication if they told you for two straight days that they never had any pain and never needed any pain medication?” Moalem said.
Their goal was to achieve a 20% reduction in opioid prescriptions at discharge which they more than tripled with a 67% reduction across 6,619 patients and 15 different surgical procedures. Of the patients discharged, 70% took home no opioids at all.
These numbers were real URMC patients: Rochester residents who went home with thousands fewer opioid prescriptions than they would have without this intervention. “You multiply that out by the thousands of pills that are not just sitting around in the Rochester area,” Moalem said. “That’s a massive, massive number of people who have been impacted.”
And the impact has been consistent. Now, five years after the study, the reductions are still holding.
It’s important to note that opioids aren’t inherently bad, and that if a patient requires pain medication, then they should have access to it. “Opioids are really, really important after surgery,” Moaelem said. “If a patient has pain that keeps them from being able to function, that needs to be treated.” The goal is the right amount of medication for the right patient, based on what they actually need.
Moaelem emphasizes that work remains to be done regarding opiate reduction and that many, many more patients will be affected. “These are not trivial decisions. We all have a responsibility to reduce the amount of these medications that are just sitting around in medication cabinets.”
