Opiate Prescribing Guidelines Following Hip Arthroscopy
Opiate Prescribing Guidelines Following Hip Arthroscopy
The purpose of the study is to determine if opiates are required to achieve appropriate
 analgesia after hip arthroscopy in outpatient surgery. The investigators hypothesize that
 patients are frequently prescribed more opiates than are needed after surgery, resulting in
 excess medications that are at risk for misuse, diversion and contribution to the opioid
 epidemic
Perioperative pain management is an important aspect of quality patient care. Opioid pain
 medications are increasingly being used for pain control, with the United States writing over
 250 million prescriptions for painkillers per year. Increased usage has led to unintended
 negative consequences for individuals and society. It is estimated that 46 people die each
 day from an overdose of prescription painkillers, and individual use can lead to the
 development of tolerance and worse treatment outcomes. Further issues arise when opioids are
 misused, it is estimated that nontherapeutic use has increased three fold in recent years. In
 the United States alone in 2006 the estimated total cost of opioid prescription misuse was
 $53.4 billion, of which $42 billion was attributed to lost productivity, $8.2 billion to
 criminal justice cost and the remainder drug abuse treatment and medical complications. The
 federal government has recognized this epidemic and raised a call for clinicians to more
 responsibly prescribe opiate pain medications

 Opiate use has increased in recent years, from 2000-2010 the use of opiates in office based
 visits nearly doubled from 11.3% to 19.6% whereas there was no change in the prescribing of
 non-opioid pharmacotherapies. Further, when specifically looking at new musculoskeletal pain
 visits, one half resulted in pharmacologic treatment, with the prescribing of non-opioid
 pharmacotherapies decreasing from 38% to 29% from 2000 to 2010, respectively. The clinical
 use of opioids for post-operative pain control has also been linked to the opioid epidemic
 and risk of future abuse. Legitimate opioid use before high school graduation is
 independently associated with a 33% increased risk of future misuse after high school.

 It has been estimated that orthopedic surgeons prescribe 7.7% of all opioids in the United
 States.Special attention needs to be paid to the amount of opioid pain medications orthopedic
 surgeons prescribe to patients after ambulatory surgery, there is considerable variability
 among surgeon and procedure in regards to the amount of opioids to prescribe with many
 patients left with excess unused medication .An analysis of 250 patients undergoing
 outpatient upper extremity surgery found that on average patients consumed 10 opioid pills,
 with 19 pills left over and a total of 4,639 pills going unused in the cohort. Leftover
 prescription opioids are at risk for diversion to family and friends for nonmedical use.
 Further studies are needed to quantify the amount of opioids to prescribe for specific
 orthopedic procedures to limit excess narcotic use, misuse, diversion and contribution to the
 opioid epidemic.
Inclusion Criteria:

 -  All patients presenting to Northwestern Memorial Hospital (NMH) or to a Northwestern
 orthopaedic surgery faculty member's clinic undergoing hip arthroscopy

 -  18 years old or greater

 -  Ability to read and speak English

 Exclusion Criteria:

 -  Revision surgery

 -  Oncologic etiology

 -  Arthroscopic hip surgery that involves procedures other than labral repair,
 acetabuloplasty, CAM-plasty, IT band windowing, Iliopsoas lengthening

 -  Patients with a current indication of narcotic use

 -  Individuals unable to provide informed consent:

 -  Prisoners

 -  Pregnant women

 -  Minors/Individuals under 18 years of age