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Opioids overprescribed to patients following dermatologic surgery

Thirty-five percent of patients who underwent dermatologic surgery did not use the opioids prescribed for them afterward, indicating an overprescribing of the pain medications, according to recent study data.

Researchers conducted a prospective observational study of 212 adults (mean age, 68 years; 72% men) who underwent single skin excision, including Mohs micrographic surgery. Patients were reachable by telephone on postoperative day 3 or 4. Main outcome measures were incidence of opioid medication after surgery, percentage of prescribed opioids used in the postoperative period, and patient and surgical characteristics associated with opioid prescription and use.

Surgeries were performed most frequently on basal cell carcinoma (67%), followed by squamous cell carcinoma (26%), and melanoma or melanoma in situ (5%). Patients had a mean maximum pain score of 3.5 (0 to 10 scale), with most reporting that maximum pain occurred on surgery day (51%) or on postoperative day 1 (26%).

Seventy-two patients (34%) were prescribed opioid medication (mean prescription, 8.9 pills). These patients were younger (mean age, 65 years), had larger mean defect size (3.6 cm2) and were more likely to have undergone wound closure (primary, flap or graft). Twenty-five patients (35%) did not use any prescribed opioids, with the most frequent reason being lack of need. Of the 57 patients who filled an opioid prescription, 49 (86%) had leftover pills, 26 of whom planned to keep the pills and two who planned to properly dispose of the unused medication.

“A minority of patients in our study required opioid analgesia after dermatologic surgery and, of those who did, most required five pills or fewer,” the researchers concluded. “Given the significant morbidity of opioid misuse and abuse, we advise cautious and limited use of opioids after dermatologic surgery. It is also important to instruct patients who are prescribed opioids about the appropriate disposal of unused pills.”