B0310 - Incidence and Risk Factors of Nonsteroidal Anti-inflammatory Drug (NSAID) Use in Post-Operative Patients After the Oklahoma Senate Bill 1446 Limiting the Prescription of Narcotics for Acute Pain

Introduction: Effective postoperative pain control is an essential & humanitarian post-surgical need. Nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids are the most commonly prescribed medication for this purpose. To limit opioid related dependence and side effects, in November 2018, Oklahoma Senate Bill 1446 went into effect, implementing a 7 day restriction for acute pain opioid prescription. GI bleeding is a known notorious side effect of NSAID use. In this study we propose that limiting patient’s access to opioid pain medications in the post-operative period can lead to an increased utilization of OTC NSAIDs and contributes to the GI bleeding burden.

Methods: In our retrospective study, 500 patients were randomly selected from a pool of post-surgical patients. Of these, 410 patients met our inclusion criteria and were contacted via a letter explaining the purpose of the study and later via telephone interview. Information was recorded regarding opioid/NSAID prescription, over the counter (OTC) use of pain meds, reason for use, degree of pain control and 30-day refills. Demographic data was collected via the EMR including age, sex, ethnicity, and zip code. Descriptive analysis was used to analyse the results.

Results: The survey response was 32.9%, of which 81.5% were males. Mean age was 53 years and 81% were Caucasians. At discharge, 77% of patients were prescribed a narcotic and 63% non-narcotics (40% NSAIDS). Of these 33.3% (n=45) reported utilizing OTC NSAIDs, within 30 days of their procedure. Ibuprofen was the most commonly used OTC NSAID (91%).

Interestingly, NSAID use was not significantly different (p 0.14) between patients who were prescribed narcotics (38/45, 84%) and who were not prescribed narcotics (66/90, 73%). No significant differences were observed (p 0.56) in OTC NSAID use between patients who did (15.6%) or did not contact their provider within 30 days of discharge. As shown in the table, the sub-analysis was not significant when stratified for gender (p 0.81), race (p 0.9), ethnicity (p 0.54) or residential status (p 0.13). An increased tendency for NSAID use was noted for younger patients (p 0.06).

Discussion: Based on these findings, we conclude that the increased regulations introduced by Bill 1446 for narcotic dosing and duration for acute pain did not impact the utilization of OTC NSAIDs in the post-surgical setting. It remains to be seen if this trend changes in the coming years, and would likely command larger scale studies to better elucidate the results.