Scientific article| Volume 44, ISSUE 4, P340.e1-340.e8, April 2019

Factors Associated With Patients’ Perceived Importance of Opioid Prescribing Policies in an Orthopedic Hand Surgery Practice

Published:August 16, 2018DOI:


      The purpose of this study was to survey the attitudes and beliefs about opioids and opioid prescribing policies among patients presenting to an orthopedic hand surgery practice.


      Patients (n = 118; median age, 49 years) who presented to their regularly scheduled appointment at a major urban university medical center completed surveys assessing their sociodemographic and clinical characteristics, beliefs about prescription opioids, beliefs about opioid prescribing policies, and perceived importance of opioid prescribing policies in the department.


      Many patients were aware of potential risks of opioids (eg, 80% are aware of addictive properties) and would support opioid prescribing policies that aim to decrease opioid misuse and diversion. However, a small but important number of patients have concerning beliefs about prescription opioids (eg, 28% believe opioids work well for long-term pain) or believe that doctors should prescribe “as much medication as the patient needs” (7%). The vast majority (98%) indicated that they would like more education on opioids and that information about prescription opioids should be provided to all patients in orthopedic practices. Patients with higher educational attainment reported a greater perceived importance of opioid prescribing policies.


      The results of this study suggest that opioid prescribing strategies that promote safe and effective alleviation of pain and optimal opioid stewardship will be well received by patients.

      Clinical relevance

      Efforts to develop and test the effects of opioid prescribing policies and nonopioid pain relief strategies on opioid prescribing are merited.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Manchikanti L.
        • Singh A.
        Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids.
        Pain Physician. 2008; 11: S63-S88
        • Wachholtz A.
        • Gonzalez G.
        • Boyer E.
        • Naqvi Z.N.
        • Rosenbaum C.
        • Ziedonis D.
        Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies.
        Subst Abuse Rehabil. 2011; 2: 145-162
        • Kuehn B.M.
        Opioid prescriptions soar: increase in legitimate use as well as abuse.
        JAMA. 2007; 297: 249-251
        • Rodgers J.
        • Cunningham K.
        • Fitzgerald K.
        • Finnerty E.
        Opioid consumption following outpatient upper extremity surgery.
        J Hand Surg Am. 2012; 37: 645-650
        • Weiss A.J.
        • Elixhauser A.
        • Barrett M.L.
        • Steiner C.A.
        • Bailey M.K.
        • O'Malley L.
        • Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009–2014: Statistical Brief #219
        Healthcare Cost and Utilization Project (HCUP).
        Agency for Healthcare Research and Quality (US), Rockville, MD2017
        • Rudd R.A.
        • Seth P.
        • David F.
        • Scholl L.
        Increases in drug and opioid-involved overdose deaths—United States, 2010–2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452
        • Rauenzahn S.
        • Del Fabbro E.
        Opioid management of pain: the impact of the prescription opioid abuse epidemic.
        Curr Opin Support Palliat Care. 2014; 8: 273-278
        • Quality Center for Behavioral Health Statistics and Quality (CBHSQ)
        2014 National Survey on Drug Use and Health: Detailed Tables.
        Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality, Rockville, MD2015
        • Gauger E.M.
        • Gauger E.J.
        • Desai M.J.
        • Lee D.H.
        Opioid use after upper extremity surgery.
        J Hand Surg Am. 2018; 43: 470-479
        • Peters B.
        • Izadpanah A.
        • Islur A.
        Analgesic consumption following outpatient carpal tunnel release.
        J Hand Surg Am. 2018; 43: 189.e1-189.e5
        • Stepan J.G.
        • London D.A.
        • Osei D.A.
        • Boyer M.I.
        • Dardas A.Z.
        • Calfee R.P.
        Perioperative celecoxib and postoperative opioid use in hand surgery: a prospective cohort study.
        J Hand Surg Am. 2018; 43: 346-353
        • Kim N.
        • Matzon J.L.
        • Abboudi J.
        • et al.
        A prospective evaluation of opioid utilization after upper-extremity surgical procedures: identifying consumption patterns and determining prescribing guidelines.
        J Bone Joint Surg Am. 2016; 98: e89
        • Goyal K.
        • Everhart J.S.
        • Jamieson M.
        Narcotic wasting in hand and upper extremity surgery.
        J Hand Surg Am. 2017; 42: S17
        • Johnson S.P.
        • Chung K.C.
        • Zhong L.
        • et al.
        Risk of Prolonged opioid use among opioid-naive patients following common hand surgery procedures.
        J Hand Surg Am. 2016; 41: 947-957.e3
        • Dowell D.
        • Haegerich T.M.
        • Chou R.
        CDC guideline for prescribing opioids for chronic pain United States, 2016.
        JAMA. 2016; 315: 1624-1645
        • Zgierska A.
        • Miller M.
        • Rabago D.
        Patient satisfaction, prescription drug abuse, and potential unintended consequences.
        JAMA. 2012; 307: 1377-1378
        • Young H.W.
        • Tyndall J.A.
        • Cottler L.B.
        The current utilization and perceptions of prescription drug monitoring programs among emergency medicine providers in Florida.
        Int J Emerg Med. 2017; 10: 16
        • Zgierska A.
        • Rabago D.
        • Miller M.M.
        Impact of patient satisfaction ratings on physicians and clinical care.
        Patient Prefer Adherence. 2014; 8: 437-446
        • Onishi E.
        • Kobayashi T.
        • Dexter E.
        • Marino M.
        • Maeno T.
        • Deyo R.A.
        Comparison of opioid prescribing patterns in the United States and Japan: primary care physicians' attitudes and perceptions.
        J Am Board Fam Med. 2017; 30: 248-254
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Halbert B.T.
        • Davis R.B.
        • Wee C.C.
        Disproportionate longer-term opioid use among U.S. adults with mood disorders.
        Pain. 2016; 157: 2452-2457
        • Menendez M.E.
        • Ring D.
        • Bateman B.T.
        Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery.
        Clin Orthop Relat Res. 2015; 473: 2402-2412
        • Nota S.P.
        • Spit S.A.
        • Voskuyl T.
        • Bot A.G.
        • Hageman M.G.
        • Ring D.
        Opioid use, satisfaction, and pain intensity after orthopedic surgery.
        Psychosomatics. 2015; 56: 479-485
        • Menendez M.E.
        • Ring D.
        Factors associated with greater pain intensity.
        Hand Clin. 2016; 32: 27-31
        • Helmerhorst G.T.
        • Vranceanu A.-M.
        • Vrahas M.
        • Smith M.
        • Ring D.
        Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma.
        J Bone Joint Surg Am. 2014; 96: 495-499
        • Bot A.G.
        • Bekkers S.
        • Arnstein P.M.
        • Smith R.M.
        • Ring D.
        Opioid use after fracture surgery correlates with pain intensity and satisfaction with pain relief.
        Clin Orthop Relat Res. 2014; 472: 2542-2549
        • Parvizi J.
        • Bloomfield M.R.
        Multimodal pain management in orthopedics: implications for joint arthroplasty surgery.
        Orthopedics. 2013; 36: 7-14
        • Memtsoudis S.G.
        • Poeran J.
        • Zubizarreta N.
        • et al.
        Association of multimodal pain management strategies with perioperative outcomes and resource utilization: a population-based study.
        Anesthesiology. 2018; 128: 891-902
        • Provenzano D.A.
        • Viscusi E.R.
        Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain.
        Curr Med Res Opin. 2014; 30: 2051-2062
        • Zale E.L.
        • Ring D.
        • Vranceanu A.M.
        The future of orthopedic care: integrating psychosocial factors into orthopedic surgical practices.
        J Bone Joint Surg Am. 2018; 100: e89
        • Porter J.
        • Jick H.
        Addiction rare in patients treated with narcotics.
        N Engl J Med. 1980; 302: 123
        • Baker D.W.
        History of the Joint Commission's pain standards: lessons for today's prescription opioid epidemic.
        JAMA. 2017; 317: 1117-1118
      1. Ryan CL, Bauman K. Educational Attainment in the United States: 2015. 2016. Available at: Accessed May 14, 2018.

      2. Painkillers fuel growth in drug addiction. Opioid overdoses now kill more people than cocaine or heroin.
        Harv Ment Health Lett. 2011; 27: 4-5
        • Holman J.E.
        • Stoddard G.J.
        • Higgins T.F.
        Rates of prescription opiate use before and after injury in patients with orthopaedic trauma and the risk factors for prolonged opiate use.
        J Bone Joint Surg Am. 2013; 95: 1075-1080
        • Alter T.H.
        • Ilyas A.M.
        A prospective randomized study analyzing preoperative opioid counseling in pain management after carpal tunnel release surgery.
        J Hand Surg Am. 2017; 42: 810-815
        • Ilyas A.
        • Alter T.
        A prospective randomized study analyzing the effect of pre-operative opioid counseling on post-operative opioid consumption after hand surgery.
        J Hand Surg Am. 2017; 42: 810-815
        • Dwyer C.L.
        • Soong M.
        • Hunter A.
        • Dashe J.
        • Tolo E.
        • Kasparyan N.G.
        Prospective evaluation of an opioid reduction protocol in hand surgery.
        J Hand Surg Am. 2018; 43: 516-522.e1
        • Stanek J.J.
        • Renslow M.A.
        • Kalliainen L.K.
        The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program.
        J Hand Surg Am. 2015; 40: 341-346