Does the Strengthen Opioid Misuse Prevention Act Reduce Opioid Prescriptions Associated With Hand Surgery

PURPOSE: The opioid epidemic has become a leading cause of death in America. Various states have put into effect legislation to limit the amount of opioids that can be prescribed. In North Carolina, The Strengthen Opioid Misuse Prevention (STOP) Act came into effect January 1, 2018, which outlined new limitations on prescribing opioids to no more than 7 days after surgery. However, the efficacy of state mandated opioid laws have not been evaluated in hand surgery. METHODS AND MATERIALS: A single-center retrospective chart review was performed for patients who underwent hand surgery between January 2015 and December 2019. Patients were excluded if they were under 12 years of age, had a multisystem trauma, inpatient admission for more than 48 hours, or had incomplete records. A review of the North Carolina Controlled Substances Database (PMP Aware) was conducted to assess for preoperative and perioperative (within 30 days of surgery) prescriptions filled. The total amount of opioids filled was converted to morphine milligram equivalents (MME). The average MME was compared between those who underwent surgery prior to and after initiation of the STOP Act. Subgroup analysis was performed in patients who underwent different types of surgery including metacarpal, tendon, phalangeal, and amputation. Additional analysis was performed to evaluate the patients who received excessive amount of opioids (>600 MME). RESULTS: Of the 500 patients who met inclusion criteria for the study, 175 were in the before group and 325 were in the after group. The demographics, patient risk factors, and complications did not differ between groups. There was an overall 69.3% decrease in opioids dispensed per patient. This statistically significant decrease was also observed in metacarpal and tendon groups (84.2% and 60.9%, respectively). Although there was an observed decrease in the phalangeal and amputation groups, this finding did not reach statistical significance. Overall, there is a higher percentage of patients who received less than 300 MME after the STOP Act was enacted (84% versus 56%). CONCLUSIONS: Following implementation of the STOP Act, there has been a marked and statistically significant decrease in opioid prescription patterns associated with hand surgery. Additional multicenter and multistate studies should be considered.