Opioids, which carry a high risk for addiction and overdose, are commonly prescribed after corneal surgery. Researchers from the University of Michigan have determined that easing up on the potent drug reduces patients’ opioid use while still providing adequate pain control.

The study used two cohorts of surgery patients to first quantify opioid use and then assess the association of decreasing the number of opioid tablets. The first group (38 patients) received the standard postsurgical opioid prescription—20 tablets of combined acetaminophen 300mg and codeine 30mg. After reviewing the opioid use data from the first cohort, the researchers decreased the number of tablets prescribed at surgery to five, permitting case variation at the surgeon’s discretion. This second cohort, comprised of 44 patients, also received a detailed survey about their opioid use, adequacy of pain control and satisfaction.

The first cohort used significantly more tablets than the second cohort (mean, 8.3 vs. 4.0) and had significantly more leftover tablets (mean, 10.3 vs. 2.9). The survey responses from the second cohort revealed that 19 of 27 patients reported their pain control as adequate, and six said it was more than needed. Of the 20 participants who had leftover tablets, 17 did not dispose of leftovers, and three threw away or flushed the leftovers.

Researchers hope to encourage safe opioid storage and disposal to minimize dispersion to the community.

The study concluded that practitioners should balance patients’ pain control needs with opioid tablet prescribing after ophthalmic surgical procedures. Once they are aware of their patients’ opioid use, they can prescribe fewer tablets and reduce the chances of misuse.

Woodward MA, Zhang Y, Tannen B, et al. Association of limiting opioid prescriptions with use of opioids after corneal surgery. JAMA Ophthalmol. October 31, 2019. [Epub ahead of print].