Delayed Opioid Prescription Filling May Reduce Addiction Risk

It’s no secret that surgical procedures—whether third-molar extractions or appendectomies—result in post-operative pain. To help their patients though post-operative discomfort, dentists have long written prescriptions for opioids. The same can be said of physicians and surgeons following other kinds of medical procedures. Used as post-operative chasers, these narcotics, including oxycodone and hydrocodone, are very good at managing pain. But they are addictive, and, all too often, patients have been given more pain pills than they actually need. So what happens to all those extra pills?

PRESCRIPTION ABUSE

Statistics from the United States Centers for Disease Control and Prevention show that between 1999 and 2020 more than 263,000 Americans died due to prescription opioid overdoses. That’s five times higher than the rate of previous years.¹

But while reports indicate that healthcare providers are exercising more caution in prescribing opiates, that’s only half the story.¹ A team of researchers from the University of Michigan (UM) found that 194,452 opioid prescriptions from surgeons and dentists in 2019 were dispensed more than 30 days after writing.²

DELAYED DISPENSING

“Our findings suggest that some patients use opioids from surgeons and dentists for a reason or at a time other than that intended by the prescriber,” said the study’s lead author Kao-Ping Chua , MD, PhD, a UM pediatrician. “These are both forms of prescription opioid misuse, which is a strong risk factor for opioid overdose.”³ The study authors note that lenient state and federal laws regulating the expiration periods for controlled substance prescriptions may be part of the problem.^2,3

The researchers note that in 2019, 18 states allowed a 6-month window for prescriptions for Schedule II opioids and other controlled substances to be filled after writing. These include drugs with the highest risk for misuse. Eight states allowed these drugs to be dispensed up to 1 year after the prescription was written. ^2,3

Says Chua, “It’s perplexing that states would allow controlled substance prescriptions to be filled so long after they are written.” He believes that tightening state laws could be one way to prevent or reduce misuse associated with delayed dispensing of opioids.³

In contrast, the researchers report that in July 2019, Minnesota enacted a law prohibiting the dispensation of prescription opioids more than 30 days after writing. Subsequently, the prevalence of delayed dispensing quickly decreased compared to other states. ^2,3

ACUTE VS CHRONIC PAIN

The study authors observe that a widespread rule limiting the time window for filling opioid prescriptions might harm patients who take the drugs for chronic pain. They therefore suggest that policymakers could implement laws limiting the dispensation window only when opioids are written for acute pain. In addition, they speculate that prescribers can reduce delayed dispensing by including instructions on opioid prescriptions that would limit the time frame within which the drugs can be dispensed. ^2,3

REFERENCES

1. United States Centers for Disease Control and Prevention. Drug Overdose.
2. Chua KP, Waljee JF, Smith MA, Bahl S, Nalliah RP, Brummett CM. Estimation of the prevalence of delayed dispensing among opioid prescriptions from US surgeons and dentists. JAMA Netw Open. 2022;5:e2214311.
3. University of Michigan. Could Time Limits on Opioid Prescriptions Reduce Misuse?