By Anne Harding

(Reuters Health) – Head and neck surgery patients in Hong Kong are far less likely to be prescribed opioids than patients undergoing similar surgeries in the U.S., new research shows.

“There’s such a huge separation in opioid prescribing practices between the United States and institutions on the other side of the world,” Dr. Ryan J. Li of Oregon Health & Science University (OHSU) in Portland told Reuters Health by phone. “There has to be room to meet somewhere in the middle in terms of utilization of opioids.”

Dr. Li and his team conducted the study after a surgeon visiting from Singapore remarked on how frequently American patients were prescribed opioids after surgery. They compared 567 patients at OHSU and 253 at the Chinese University of Hong Kong (CUHK) who had similar major operations from 2013 through 2017.

On the day before surgery, 15 percent of the OHSU patients had an order in their chart for an opioid versus 2 percent of CUHK patients. Six days after their surgery, 87 percent of OHSU patients had opioid orders, versus less than 1 percent of CUHK patients. Fourteen days after surgery, 71 percent of the U.S. patients still had opioid prescriptions.

“I think this would be pretty reflective of other practices in the U.S.,” Dr. Li said.

“When we present these types of findings to our professional societies it creates a lot of buzz,” he added. “We don’t always associate our practices with being a major contributor to the opioid crisis. It’s obviously a gateway for patients to potentially abuse these drugs.”

Minimizing opioid use requires optimizing pain management with non-opioid treatments such as acetaminophen and nonsteroidal anti-inflammatory drugs, Dr. Li noted.

“It doesn’t mean we’re trying to cut opioids out of the picture,” Dr. Li said. “I don’t think it’s really ‘opioids are the enemy.’ Our responsible prescribing of these things is what’s going to make a difference.”

SOURCE: JAMA Otolaryngology Head & Neck Surgery, online September 6, 2018.