Reducing postoperative narcotic use in opioid naive patients utilizing a standardized opioid titration protocol

Background: Due to the current opioid crisis, physicians and policymakers are increasingly focusing on ways to decrease opioid overuse and misuse in the United States. Surgeons are noted to be some of the highest prescribers of opioids. When prescriptions are issued for acute postoperative pain management to opioid naive patients, the risk for acute opioid use progressing to chronic use can become problematic. Objective: To implement an evidence-based standardized opioid titration protocol postoperatively to improve clinical practice and reduce long-term postoperative opioid exposure in the orthopedic clinic. Method: To improve quality of care, we developed and implemented a standardized opioid titration protocol and applied it to 25 postoperative patients over a six-week period. The protocol consisted of a four-step process, which allowed opioid narcotics to be systematically weaned down consistently over a six-week process. We evaluated patient pain levels and prescription refills biweekly to determine efficacy. Results: 98% (n=24) of patients experienced satisfactory pain relief by week 6, 71% (n=17) of patients stopped opioid use by week 2, and 100% (n=25) of patients did not require further refills after 4 weeks. When compared to prior prescribing practices, overall refill rates were found to be significantly decreased by 10% (p= 0.025). Implications: Implementation of a standardized opioid titration protocol was associated with fewer opioid pills being prescribed, fewer requests for opioid prescription and fewer refills, in addition to lower pain scores.