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Florida House Bill 451 was not Associated with a Decrease in Postoperative Opioid Prescribing for Acute Pain at a Single Institution

This law surmises that opioid prescribing will be affected by engaging patients and prescribers in the decision of what pain medications and therapies to prescribe. Whether these additional new patient education regulations influenced clinician-based opioid prescribing for postoperative surgical patients is unknown. We hypothesized that these new regulations would not further impact opioid prescribing for postoperative surgical patients. Using similar methodology from prior work we compared opioid prescribing at discharge from surgery at our institution for July 1, 2018, through March 31, 2019 (pre-HB451), and September 1, 2020, through April 30, 2021 (post-HB451) across 25 surgeries. Opioid prescriptions were converted to oral morphine equivalents (OME). We investigated: 1) receipt of opioids at discharge (yes/no); (2) discharge OME; and (3) >200 OME at discharge (approximately 1 tablet of 5 mg oxycodone every 6 hours for 7 days). Chi-squared and Wilcoxon Rank Sum tests and interrupted time-series analyses tested prescribing changes after HB451. We used months as units of time and abstracted opioid refills as a potential counterbalance to a reduction in the initial dose of opioids allowable. Overall, we did not find an association of HB451 on whether patients were prescribed any opioids at discharge (70.8% vs 73.2% pre-post, P = .071); the mean (SD) and median dose of OME at discharge (173 [258] vs 155 [164] and 90 vs 90, P = .239); or the percent of patients prescribed an OME >200 (32.8% vs 33.3%, P = .750). However, the refill rate did decrease pre-post (23.0% vs 18.2%, P = .0001). Of the 25 surgeries studied, 4 significantly decreased (lumbar laminotomy, lumbar laminectomy, open ileocecectomy, and laparoscopic low anterior resection) while 6 significantly increased (total shoulder arthroplasty, breast lumpectomy, parathyroidectomy, thyroid lobectomy, knee arthroscopic meniscectomy, and laparoscopic inguinal hernia repair) mean and median opioid prescribing. Within opioid-naı̈ve patients, we did not detect a difference pre-post in the percent of patients prescribed any opioids at discharge (74.0% vs 76.4%, P = .111); nor the percent of patients prescribed an OME greater than 200 (30.2% vs 33.0%, P = .09. We did detect a statistically significant, but clinically insignificant, increase in the mean (SD) and median dose of OME at discharge (152 [178] vs 153 [146] and 90 vs 90, P = .023). We again detected a decrease in the refill rate pre-post (19.6% vs 14.2%, P < .0001). We did not detect a statistically significant difference in the interrupted time series analysis of the decrease in mean OME prescribed over time (P = .24) (Figure 1). The COVID-19 epidemic has only worsened the opioid epidemic, and state governments are continuing to attempt to legislate solutions to this problem.We sought to quantify the effect of HB451, a law focused on patient education regarding non-opioid alternatives for pain control, on opioid prescribing for acute postoperative pain at our institution. We did not detect a significant decrease in the percent of patients prescribed any opioids at