Association Between a Statewide Medicaid Opioid Policy and Postoperative Opioid Prescribing among Surgeons at a Large Safety-Net Hospital

Thesis (Master's)--University of Washington, 2022Background: Restrictive state and payer policies may be effective in reducing opioid prescribing by surgeons, but their impact has not been well studied. In 2017, Washington Medicaid implemented an opioid prescribing limit of 42 pills, prompting a large regional safety-net hospital to implement a decision support intervention in response. We aimed to evaluate the effects on surgeons’ prescribing. Study Design: We retrospectively studied postoperative opioid prescribing (quantity of pills prescribed at discharge) to opioid-naïve surgical patients at a regional safety-net hospital from 2016 to 2020. We investigated associations between the policy and opioid prescribing using interrupted time series analysis (ITSA), adjusting for clinical and sociodemographic factors. Results: 12,799 surgical encounters involving opioid-naïve patients (59% male, mean age 52) were analyzed. Opioids were prescribed for 75%. From 2016 to 2020, the mean prescribed opioid quantity decreased from 36 pills to 17 pills. In ITSA, the Medicaid policy implementation was associated with an immediate change of -8.4 pills (95% CI -12 to -4.7, p