Opiate Prescribing Guidelines Following Hip Arthroscopy
Condition: Hip Injuries
MeSH terms: Hip Injuries
Study type: Interventional

Summary: 
      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
    

Detailed description: 
      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.
    

Intervention name(s): Group 1 - Opiate Tablets post Hip Arthroscopy; Group 2 - Opiate Tablets post Hip Arthroscopy
Intervention type(s): Other; Other
Intervention description(s): Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens.; Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens.
Intervention MeSH terms: Opiate Alkaloids
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: Hip Arthroscopy; Opiate Use