Mohs surgeons prescribing less opioids
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Key takeaways:
- Fewer Mohs surgeons have prescribed opioids following repair procedures since 2014.
- Physicians have also favored shorter duration of opioid prescriptions in the past two decades.
SAN DIEGO — Since 2014 the number of opioid prescribers and prescriptions among Mohs surgeons has decreased, suggesting practices have evolved to avoid dependency, according to a presentation here.
“Mohs micrographic surgery can cause postoperative pain, particularly when complex repairs are required,” Amy P. Rossi, PhD, of the University of Cincinnati College of Medicine, and colleagues wrote in a poster abstract presented at the American Academy of Dermatology Annual Meeting. “While opioids are a reasonable choice for pain control in some cases, the risks of dependency and overdose warrant opioid stewardship.”
Rossi and colleagues conducted a retrospective analysis from Medicare Parts B and D data, evaluating how many Mohs surgeons prescribed opioids and the number of prescriptions per 100 procedures between 2014 and 2021.
In 2014, 47.3% of Mohs surgeons prescribed opioids for a median of 3.2 days. This was followed by 48.5% of surgeons prescribing opioids for a median of 3.1 days in 2015, and 46.1% prescribing them for a median of 3 days in 2016. The median per 100 repairs was 15.2 in 2014.
In 2014, the percentage of opioid prescriptions included 67.4% for hydrocodone, 13.3% for codeine, 0.7% for oxycodone and 0.4% for tramadol. The proportion of oxycodone prescriptions rose in 2015 to 2.2% and 2016 to 2.8%, respectively. Tramadol increased to 1% in 2015 and 1.5% in 2016. Compared with 2014, there were also more codeine prescriptions in 2015 (18.5%) and 2016 (18.1%), whereas hydrocodone prescriptions fell to 56.9% in 2015 and 55.3% in 2016.
After 2016, the number of prescribers continued to decline, reaching 33.8% in 2021. The number of days supplied also fell to 2.8, with hydrocodone making up 46.6% of prescriptions, tramadol 14.5%, oxycodone 1% and codeine 13.8%. The median prescriptions per 100 repairs fell to 10 in 2021.
“Taken together, these data suggest that Mohs surgeons’ opioid prescribing practices have evolved to use opioids less frequently for analgesia and to favor shorter courses of opioids with lower potential for dependency,” the authors wrote.
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Rossi AP, et al. Opioid prescribing practices among Mohs surgeons from 2014 through 2021. Presented at: American Academy of Dermatology Annual Meeting; March 8-13, 2024; San Diego.
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