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American Association for Hand Surgery

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The Impact of the Florida Law HB21 on Opioid Prescribing Patterns After Outpatient Hand Surgery
Moses I Markowitz, BS, Juan J Lizardi, MS, Joseph S Geller, MD, Sinan K Jabori, MD and Seth D Dodds, MD, University of Miami Miller School of Medicine, Miami, FL

Introduction:
The United States comprises about 5% of the world's population, yet accounts for close to 80% of all opioids consumed. This epidemic is largely fueled by over-prescription, as hundreds of thousands of opioid prescriptions are dispensed each year. In an effort to reduce the opioid prescription rate, the state of Florida implemented House Bill 21 (HB21) on July 1, 2018. This bill limits the supply of Schedule II opioids to three days for acute pain prescriptions, with the ability to extend to a seven-day supply if an exception is documented. The purpose of this study is to evaluate the effects of Florida law HB21 on opioid prescribing patterns by a single orthopaedic surgeon after outpatient hand and upper extremity surgery.
Materials and Methods:
Opioid prescriptions were assessed with retrospective chart review. The following variables were compared before and after implementation of law HB21: type of opioid prescribed, number of pills prescribed, morphine milligram equivalents (MMEs) prescribed, unplanned emergency department visits, and unplanned readmissions. Statistical significance for age, BMI, number of pills dispensed, and MME's was determined using an independent t-test. Significance for unplanned emergency department readmissions and unplanned reoperations was assessed using Fisher's exact test. p<.05 was considered significant.
Results:
We reviewed 231 consecutive patients from July 2017 to July 2018 and 207 consecutive patients from January 2020 to January 2021. There were no differences between the two groups with respect to age (48.41 versus 44.98 years, p=.387), sex (117 females versus 114 males, p=.50) or BMI (27.2 versus 27.0, p=.382). The average number of pills prescribed per patient decreased significantly after the law was implemented (25.11 versus 21.7 pills, p=.001), however, the number of morphine milligram equivalents (MMEs) prescribed per patient was not statistically different before and after the law (167.8 versus 153.6 MMEs, p=.206). There were no significant differences in unplanned postoperative emergency department visits (3 versus 0, p=.25), hospital admissions (6 versus 3, p=.51), or reoperations (3 versus 3, p=1.0) before and after the implementation of HB21.

Conclusion:
While Florida law HB21 may have resulted in fewer pills prescribed per patient, it did not significantly affect the MME's prescribed, suggesting that legislation may not change prescriber behavior or patient demand regarding postoperative opioid prescriptions after outpatient hand and upper extremity surgery.


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