Opiates Prescribing for Knee Arthroscopies and ACL Reconstruction
Condition: Knee Injuries; ACL Injury
MeSH terms: Wounds and Injuries; Knee Injuries; Anterior Cruciate Ligament Injuries
Study type: Interventional

Summary: 
      The purpose of the study is to determine if opiates are required to achieve adequate
      analgesia after knee arthroscopy and ACL reconstruction 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 non-therapeutic 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-Knee Arthroscopy; Group 2-Knee Arthroscopy; Group 1-ACL reconstruction; Group 2-ACL reconstruction
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected.; Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed.; 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Other