New guidelines for opioid prescribing practices for dermatologists

In an effort to reduce opioid prescribing following dermatologic procedures, a group of 40 board-certified dermatologists, including Mohs micrographic surgeons, dermatopathologists and cosmetic dermatologists convened to develop consensus recommendations for opioid management.

The recommendations were published online ahead of print in the Journal of the American Academy of Dermatology (Nov. 12, 2019).

“The hope is that this will serve as a tool to help safely guide the management of patients’ post-procedural pain,” said Dr. Lindsey Collins in an American Academy of Dermatology press release. Dr. Collins is a dermatologist and Mohs surgeon, who was a part of the guidelines’ creation.

“We think it will help curb potential opioid misuse by addressing pain in a procedure-specific manner.”

Following an extensive discussion, the panel of dermatologists developed recommendations for 87 of the most common dermatologic procedures, measured by morphine milligram equivalents (MME):

  • Routine opioid prescriptions are unnecessary for 66 of the procedures, as these can be adequately managed with acetaminophen and/or ibuprofen.

  • A prescription of 1 to 10 opioid tablets (equal to oxycodone 5 mg) for the duration of the patient’s recovery may be necessary for 16 of the procedures, including scalp and cheek reconstruction.

  • A prescription of 1 to 15 opioid tablets (equal to oxycodone 5 mg) for the duration of the patient’s recovery may be necessary for only one of the procedures: upper lip reconstruction, known as the Abbe flap.

  • No procedure routinely requires more than 15 opioid tablets (equal to oxycodone 5 mg).

According to Dr. Justin McLawhorn, the study’s lead author and dermatology resident at the University of Oklahoma Health Sciences Center, many of the procedures that require 1 to 10 opioid tablets are performed by dermatologists and Mohs surgeons on a daily basis.

The only scenario requiring up to 15 opioid tablets is a complex repair that is not often performed. Dr. McLawhorn also notes that the recommendations are presented in a quick-reference manner, enabling dermatologists to easily consult the suggested personalized pain management for their patients.

The study’s authors hope the new recommendations will resonate with patients.

“We think patients will appreciate that their dermatologists are taking steps to limit the over-prescription of opioid pills,” said Dr. Collins.

Overdose deaths involving prescription opioids increased by nearly 400% from 1999 to 2017, according to the Centres for Disease Control and Prevention (CDC) and the National Institutes of Health.

The CDC warns that taking prescription opioids for long periods can increase the risk of addiction and overdose.

“Countering the opioid epidemic will require physicians to re-evaluate their current practice patterns, and we are providing this tool for dermatologists as a starting point to reduce opioid addiction and opioid-related deaths,” said Dr. McLawhorn. “These guidelines are one step in the process of producing meaningful change in the prudent use of opioids.”

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