News From AAOS: Orthopedic Trauma Patients Shop Doctors for Narcotics

A new study presented at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans, La., demonstrates that among postoperative orthopedic trauma patients, attempts to obtain narcotic prescriptions from multiple physicians is on the rise.

In “Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Population,” researchers reviewed prescription records for 151 adult patients admitted to an orthopsedic unit at a level one trauma center between January and December 2011. Using the Tennessee Controlled Substance Monitoring Database, researchers compiled data on narcotic prescriptions obtained three months before, and within six months after, each patient’s orthopedic procedure.

The study found that overall, 20 percent of patients were “doctor shopping.” The group that sought multiple providers for postoperative narcotics (“doctor shoppers”) used narcotics four times longer than single provider patients (112 days versus 28 days); had a median of seven narcotic prescriptions compared to two prescriptions; and had a higher morphine equivalent dose each day (43 milligrams versus 26 milligrams) than the single provider group.

The study also found that patients were 4.5 times more likely to seek out an additional provider if they had a history of preoperative narcotic use. The study authors recommend close monitoring of narcotic prescriptions and related requests following orthopedic surgery.

In 2006, a study published in the Journal of Bone & Joint Surgery found a connection between orthopedic trauma patients and depression. Out of 161 trauma patients in the study measured on the Beck Depression Inventory, Fifty-five percent had minimal depression, 28 percent had moderate depression, 13 percent had moderate-to-severe depression, and 3.7 percent had severe depression. The study concluded that the prevalence of clinically relevant depression approached 45 percent in a diverse cohort of orthopedic trauma patients, and the presence of an open fracture may also increase the risk of depression.