Abstract 4: A Simple Way to Reduce Opioid Over-Prescribing by Plastic Surgery Residents

BACKGROUND: Over-prescribing following surgery is a known contributor to the opioid epidemic, increasing the risk of opioid abuse and diversion. Trainees are the primary prescribers of these medications at academic institutions, and we previously identified over-prescribing in this population across the US and Canada. We hypothesized that a simple “intervention” could improve over-prescribing METHODS: All plastic surgery trainees at one institution completed an anonymous survey querying opioid-prescriber education, factors contributing to prescribing practices, and analgesic prescriptions written after eight common procedures. Oral morphine equivalents (OME) were calculated for each procedure. A simple 4-hour intervention was then administered to all residents in 1-hour sessions, during grand rounds over several weeks: (1) screening of HBO’s documentary “Warning: This Drug May Kill You”, (2) St. Louis Police Department on opioid abuse and crime; (3) experienced psychologist on treating patients with opioid addictions; (4) Pain Management Anesthesiologist on the basic science of pain and analgesia. Surveys were repeated several months after completing the intervention. Pre- and post-intervention prescriptions were compared using either students t-test or Mann-Whitney U tests, depending on data normality as determined by the Shapiro-Wilks test RESULTS: Response rate was >90% on both surveys. For all but 2 procedures (carpal tunnel release and abdominoplasty), there was a statistically significantly decrease in prescribed MME after the intervention. Residents more frequently adjusted prescriptions to specific procedures (from 53% to 95%, p=0.002). There was no change in the number of residents adhering to the “one-prescriber rule” (37% to 50%, p=0.408). CONCLUSION: A largely passive intervention can improve over-prescribing by plastic surgery residents. Coordination of care issues remain a problem, such as following the “one-prescriber rule.” The intervention can be easily adopted: (1) it simply raised awareness – no mandatory prescribing protocols. (2) Three of the 4 hours are available, to other training programs, now – and for free: Two of the 3 hours of in-person lectures were converted to Prezi’s and narrated, and are available here: https://surgicaleducation.wustl.edu/. The HBO supports public screenings of its documentary. Further work can define (1) minimums for interventions to “raise awareness”, and (2) the role post-op protocols play in reducing over-prescribing.

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