Perioperative Opioid Use after ACL Reconstruction before versus 5 Years after the Prescriber Limits Act in Maryland: A Retrospective Cohort.

Abstract

Efforts to combat the opioid epidemic in the United States have come in various forms. In 2017, the Maryland General Assembly passed the Prescriber Limits Act, which required providers to prescribe the lowest effective quantity of opioids to treat specified pain. The purpose of this study was to analyze how opioid prescribing and filling behavior after primary anterior cruciate ligament (ACL) reconstruction has changed since the implementation of the Prescriber Limits Act of 2017.Patients who underwent ACL reconstruction by a single surgeon at a single, urban, academic institution from June 2015 to November 2023 were retrospectively identified. Opioid prescription-filling behavior was obtained from the medical record and confirmed with the regional Prescription Drug Monitoring Program (PDMP). Prescriptions were identified from 1 year preoperatively to 2 years postoperatively and were converted to morphine milligram equivalents (MME). Each prescription was categorized as discharge or refill based on the date filled relative to the date of surgery. Opioid-naïve patients without a preoperative opioid prescription within 1 year of surgery who underwent ACL reconstruction "pre-legislation" from 2015 to 2017 were compared to opioid-naïve patients who underwent ACL reconstruction "post-legislation" from 2022 to 2023. Multivariable regression analysis was performed to identify predictors of opioid refill after ACL reconstruction.There were 74 patients in the pre-legislation group and 77 in the post-legislation group. Post-legislation discharge MME was significantly less than pre-legislation (53.4 ± 31.0 vs. 757.7 ± 186.5, <i>p</i> < 0.001). Patients in the post-legislation group were also less likely to refill an opioid postoperatively (odds ratio [OR] = 0.18; <i>p</i> < 0.001) and averaged less refill MME postoperatively (5.8 ± 21.0 vs. 198.4 ± 328.3, <i>p</i> < 0.001). At 4 weeks postoperatively, 6.8% of the pre-legislation group had additional opioid refills, while the post-legislation group had no refills (<i>p</i> = 0.026). Logistic regression analysis found discharge MME was the only predictor of refilling an opioid postoperatively (<i>p</i> = 0.002).This retrospective review of ACL reconstruction perioperative opioid prescribing before and after opioid-limiting legislation in Maryland found significant decreases in the quantity of opioids prescribed at discharge, decreased refill rates, and earlier cessation of opioid use postoperatively.