• Akash Goel, Adina Feinberg, Brandon McGuiness, Sav Brar, Sanjho Srikandarajah, Emily Pearsall, Robin McLeod, and Hance Clarke.
• From the Department of Anesthesia, University of Toronto, Toronto, Ont. (Goel); the Harvard T.H. Chan School of Public Health, Boston, Mass. (Goel, McGuiness); the Department of Surgery, University of Toronto, Toronto, Ont. (Feinberg, Brar, Pearsall, McLeod); the Department of Vascular Surgery, McMaster University, Hamilton, Ont. (McGuiness); the Department of Surgery, Mount Sinai Hospital, Toronto, Ont. (Brar); the Department of Anesthesia, North York General Hospital, Toronto, Ont. (Srikandarajah); and the Department of Anesthesia, University Health Network, Toronto, Ont. (Clarke).
• Can J Surg. 2020 Jan 9; 63 (1): E1-E8.

BackgroundOverprescribing of opioids to patients following surgery is a public health concern, as unused pills may be diverted and contribute to opioid misuse and dependence. The objectives of this study were to determine current opioid-prescribing patterns for common surgical procedures, factors that affect surgeons’ prescribing behaviour and their perceived ability to manage patients with opioid use disorder.MethodsSurvey participants included all consultant and trainee surgeons at the University of Toronto. The survey, which was administered electronically, included 52 multiple-choice, rank-order and open-text questions eliciting information on current prescribing patterns, prescribing of adjunct pain medications, and education and other factors related to opioid prescribing. Staff surgeons were also asked about how they manage patients with a suspected opioid issue.ResultsEighty surgical trainees and 40 staff surgeons responded to the survey (response rate 32%). Five staff surgeons (12%) felt adequately educated to prescribe pain medications (including opioids) at discharge. Staff surgeons prescribed Tylenol 3 more frequently than other opioids. Twenty (51%) of 39 staff surgeons reported that they sought further help for their patients when an opioid use disorder was suspected.ConclusionOur results support existing studies showing a large degree of variability in postoperative opioid prescribing. Institutional guidelines have been shown to be effective in curbing excessive opioid prescribing without increasing unnecessary emergency department visits for uncontrolled pain. Thus, there is an opportunity to develop institutional guidelines to educate surgical teams in the prescribing of opioids and about services available for patients with a substance use disorder.© 2020 Joule Inc. or its licensors

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