Opioid Prescribing Down in Oculoplastic, Orbital Surgery After Michigan Opioid Laws

This illustration image shows tablets of opioid painkiller Oxycodon delivered on medical prescription taken on September 18, 2019 in Washington,DC. – Millions of Americans sank into addiction after using potent opioid painkillers that the companies churned out and doctors freely prescribed over the past two decades. Well over 400,000 people died of opioid overdoses in that period, while the companies involved raked in billions of dollars in profits. And while the flood of prescription opioids into the black market has now been curtailed, addicts are turning to heroin and highly potent fentanyl to compensate, where the risk of overdose and death is even higher. (Photo by Eric BARADAT / AFP) (Photo by ERIC BARADAT/AFP via Getty Images)
Surgeons in Michigan are prescribing fewer postoperative drugs following procedures.

Opioid prescribing steadily declined for oculoplastic and orbital procedures during the enactment period of Michigan’s statewide opioid legislation of 2017 and 2018, researchers found in a cross-sectional retrospective review published in JAMA Ophthalmology.

Michigan Opioid Laws refers to a  legislation package that required prescribers — prior to prescribing opioids — to teach safe use and disposal of opioids, as well as to obtain patients’ signed consent to the instructions, and review and track the patient’s opioid use history through an electronic database to assess patient risk over time. The legislation was rolled out in multiple phases and utilizes the Michigan Automated Prescription Program.

The researchers reviewed clinical data of 3781 adult patients (1614 males) who underwent any of 10 common oculoplastic and orbital procedures from June 1, 2016 to November 30, 2019, at the University of Michigan’s tertiary care institution. They collected details on outpatient opioid prescriptions that physician faculty, trainees, or mid-level practitioners at the University of Michigan Medical School ordered before, on the day of, or immediately after the surgery.

Practitioners prescribed opioids to 2660 of the 3781 patients for postoperative analgesia: 1782 of the 2026 patients who underwent surgery before June 1, 2018 (88% of the patients) and 878 patients (50%, P <.001) who underwent surgery after that date. Demographics and procedure type between the 2 cohorts remained the same. Nearly all – 2612 (98.2%) of the 2660 – of the patients who received postoperative opioid prescriptions had complete pharmacologic information to allow for morphine milligram equivalent (MME) calculation.

Acetaminophen-hydrocodone was the most common (n=2279 [87.3%]) of the 6 types of opioids that were prescribed. The mean prescription amount was 80.1 MMEs (standard deviation (SD): 51.4 MMEs). The highest mean prescription amount was for acetaminophen-tramadol, at 337.5 [SD: 0] MMEs, followed by hydromorphone (187.0 [SD: 123.4] MMEs), oxycodone (175.5 [SD: 105.9] MMEs), and acetaminophen-oxycodone (130.3 [SD: 77.0] MMEs). The mean amount of opioids prescribed was higher than the overall mean of 80.1 MMEs for the following orbital procedures: periorbital approach to orbital floor fracture repair (117.1 [SD: 61.6] MMEs), enucleation with orbital implant (108.1 [SD: 69.6] MMEs), and orbitotomy for decompression with bone flap (91.5 [SD: 41.5] MMEs. Soft tissue procedures had a lower mean amount of opioids prescribed (brow-lift: 64.7 [SD: 30.5] MMEs; blepharoptosis repair: 73.2 [SD: 37.8] MMEs).

With linear interpolation spline regression analysis, the researchers found that there were -1.735 MMEs prescribed per month from June 1, 2017, to September 30, 2018, which was a total decrease of 26.025 MMEs (β, -1.735; 95% confidence interval (CI), -0.088 to -0.024; P <.001). The rate appeared to reduce and sustain through November 30, 2019 (β, -0.005; 95% CI, -0.039 to 0.016; P =.42). The analysis did not show changes in MME prescribed from June 1, 2016, to May 31, 2017: β, -0.005; 95% CI, -0.027 to 0.016; P =.61). 

Opioid prescriptions decreased 36.2% from the June 1, 2016 to May 31, 2017, period, which saw a mean amount of 93.4 (SD: 52.9) MMEs prescribed, to the October 1, 2018, and November 30, 2019, period, which saw a mean amount of 59.6 (SD: 44.3) MMEs prescribed. 

Opioid prescriptions for each type of surgical procedure declined similarly across the years, the researchers said.

“Increasing awareness, communication, and education for both prescribers and patients regarding postoperative opioid use and the potential for abuse and diversion are promising tools to prevent opioid overprescription,” according to the research. “Enactment of legislations similar to the Michigan Opioid Laws across other states or at a national level may help to further combat the national prescription opioid epidemic.”

Limitations of the study included obtaining the data from solely 1 tertiary care academic institution; data for any patients’ possibly obtaining opioid prescriptions through other means is unavailable.

Disclosure: One study author declared an affiliation with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Xie Y, Joseph AW, Rudy SF, et al. Change in postoperative opioid prescribing patterns for oculoplastic and orbital procedures associated with state opioid legislation. JAMA Ophthalmology. Published online December 10, 2020. doi:10.1001/jamaophthalmol.2020.5446