Prevention of Opioid Use Disorder After Surgery: A Pilot and Feasibility Study

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The United States is in the midst of an opioid use crisis, including a disturbing rise in deaths from opioid overdoses and devastating personal and societal effects of opioid use disorder (OUD). OUD often starts with prescription opioid use, such as for the treatment of moderate to severe pain in post-operative patients. Previous studies have shown that a substantial number of patients who receive opioids for common surgical procedures develop persistent opioid use, a necessary first step towards OUD and its sequelae. A balanced approach to postoperative pain management for surgical patients is urgently needed to prevent persistent post- operative opioid use before it develops, thus helping to stem the tide of the opioid use crisis while still managing patients’ pain. The objective of this study is to design and pilot test the feasibility of a Multi-faceted persistent Opioid use Prevention Program (MOPP) to support safer opioid prescribing, self-administration and monitoring, and reduce persistent opioid use and opioid misuse for patients transitioning to the community setting after major orthopedic surgery. The multi-faceted intervention includes: 1) pharmacist-led discharge counseling of patients and caregivers and communication with post-discharge providers; 2) standardized opioid prescribing discharge order sets for each surgery type; 3) a post-discharge pain management follow-up visit (with additional contact as needed) embedded within routine post-operative care for managing pain and opioid use; and 4) a patient engagement pain management app for assessing pain, function, and possible development of OUD. These components have shown promise in prior studies of chronic opioid use but have not been previously implemented or evaluated in combination in this population with a goal of preventing persistent opioid use. The design of MOPP and its implementation will be continuously guided by a patient-family advisory council and diverse stakeholder steering committee and interdisciplinary working group. The primary outcome of the intervention will be persistent opioid use (in the 6 months after surgery) based on state-wide prescription data. Secondary outcomes will include long-term opioid episodes; morphine-equivalent dose of opioids prescribed at discharge; total post-operative opioids dispensed in the 6 months after surgery; self-reported pain, function, and signs or symptoms suggestive of opioid misuse 90 and 180 days after surgery; and post-operative healthcare utilization. We will measure intervention fidelity and use the Consolidated Framework for Implementation Research (CFIR) to guide qualitative interviews of patients, caregivers, and providers to identify barriers and facilitators of implementation. These approaches will help improve the implementation plan and provide lessons learned for future implementation efforts. The proposed study will provide valuable preliminary data to inform the development of a larger study to design, implement, and evaluate effective strategies to prevent persistent opioid use and subsequent opioid use disorder for post-surgical patients.