Rahul Shah, University of Texas

Older adults are being prescribed opioids at an increased rate after joint replacement surgery, despite limited effectiveness and against federal, state and payer advice, a new study has found.

Researchers from the University of Texas examined the rates of opioid prescribing and level of pain control in patients who underwent total hip arthroplasty and total knee arthroplasty from 2014 to 2017. They found a substantial increase in the percentage of patients receiving opioids. Yet there was “no clinically meaningful improvement in postoperative pain level at discharge or even up to two months after surgery,” reported lead author Rahul Shah and colleagues.

Notably, patients who underwent total hip replacement and were insured with Medicare only or with Medicaid only were more likely to receive at least one opioid prescription within 60 days of hospital discharge, compared with those who were not insured in this manner.

The results suggest that policies aimed at curbing postoperative opioid overprescribing have not been effective, the authors wrote. “Our findings underscore the need to monitor effectiveness of policies in the real-world setting,” they concluded.

Among the study’s limitations was a lack of data on whether patients actually used the prescribed opioids, the researchers said.

Full findings were published in JAMA Network Open.