Mia Woodward, MD: Opioid Prescribing Post-Corneal Surgery

A recent study from investigators at the University of Michigan found that patients prescribed opioids after corneal surgeries were often given more than they needed and they failed to properly dispose of unused pills.

Investigators examined the use of opioids in patients post-surgery both before and after policy changes that limited the amount of opioids prescribed. They found that after they cut down the amount that patients were given, patients still were not using the entire prescription — with nearly 65% reporting to have leftover pills and 85% of that group also reported failing to dispose of those leftover pills properly.

Mia Woodward, MD, associate professor of ophthalmology and visual sciences at the University of Michigan Kellogg Eye Center, was one of the study's investigators and sat down with MD Magazine® to discuss the findings of the study at the 2019 Annual Meeting of the Association for Research in Vision and Ophthalmology.

MD Mag: What prompted your interest and what were the results of your study examining opioid use after corneal surgeries?

Woodward: We really do see people who can be addicted to opioids after surgery. There is a wonderful group of researchers of the Institute for Health Policy and innovation at University of Michigan and they were studying post-surgical opioid use and really finding that you can get addicted to opioids after your surgery on the opioids you're given to manage the post-operative pain and so I am colleagues with those people and realized that this was a problem in my own domain as well. So, with the cornea service we looked at how many pills, opioid pills, after surgery we were prescribing and compared that to how many pills patients were using by calling patients about a week after their surgery and they were using way less than we were prescribing. So, really, we did that study over six weeks and then met with about a month later and immediately curtailed how many we gave and get started giving a lot less but then we also wanted to do follow-up and make sure by giving less we were still managing the pain properly and also understand more about the opioid use.

So, we called patients another set of patients, a second set of patients, and found that we were really adequately controlling their pain. When you prescribed less they actually use less and I think there's a lot more of a conversation about opioids now that we talk to our patients at the time of surgery but the scary thing from the results of the study is that they still weren't dispensing the any unused pills properly. So, we really didn't have any patients who were doing the right thing dropping them off at a police station or bringing them back to a Medical Center for proper dispensing because of course what we're worried about is you know just dispersion into the community.

You know, I think that we, especially in the context of surgery, it's difficult because of course people are worried about their surgery and then you sort of think about the pain control after that and so we still need to think about the whole surgical care of a patient, which is not only what are the risk factors for the surgery, what's a surgery outcome likely going to be but what's the whole surgical care experience.

We need to incorporate those conversations earlier because now that we are doing that more and now that the state of Michigan also mandates that we give education to our patient so it's really helped I think the communication that it's not taboo to talk about or ask about or understand about people's pain and what they should be doing with pain control.