Limitations on Post-Operative Opioid Prescriptions and Effects on Healthcare Resource Utilization Following Elective Anterior Cervical Discectomy and Fusion.

OBJECTIVE To curb the misuse of post-operative prescription opioids, the state of North Carolina enacted the Strengthen Opioid Misuse Prevention (STOP) Act of 2017 limiting the duration of initial post-operative opioid prescriptions. The purpose of this study was to evaluate the STOP Act's effect on healthcare resource utilization by comparing patient outcomes and opioid prescribing practices following elective anterior cervical discectomy and fusion (ACDF). METHODS Outcomes and opioid prescribing data were retrospectively evaluated for Pre-Law (January 1, 2017 to December 31, 2017 ) and Post-Law (January 1, 2018 to December 31, 2018 ) elective 1 to 4 level ACDF patient cohorts. Outcome measures included hospital and clinic resource utilization in the form of emergency department visits, readmissions, major post-operative complications, number of clinic visits, or number of clinic phone calls by patients reporting uncontrolled pain or requesting new opioid prescriptions. Opioid prescribing practices in the form of discharge prescription number of pills and total morphine milliequivalents (MME) were also recorded. RESULTS Surrounding the STOP Act's implementation, there was no significant difference (P>0.05) in emergency department visits, readmissions, major complications, number of post-operative clinic visits, or number of clinic phone calls for uncontrolled pain or new prescription requests. There was a significant decline in mean discharge prescription number of pills (89.7 versus 67.0, P<0.001), and average MME (683.4 versus 509.6, P<0.001). CONCLUSION This may reflect over-prescribing in this population, where larger opioid prescriptions were likely not needed to manage pain that would otherwise require a return to care.