Patterns of opioid prescribing to opioid-naive patients after surgical and emergency care: A population-based cross-sectional study using linked administrative databases in Nova Scotia (2017-2019).

Introduction: To describe opioid prescribing patterns for opioid-naive patients who filled prescriptions after surgical or emergency care.

Methods: We conducted a population-based, cross-sectional study of opioid-naive adults who filled opioid prescriptions within 14 days of receiving surgical or emergency care in Nova Scotia, Canada. Using linked administrative databases, we estimated the prevalence of opioid prescriptions with >7 days' supply, ≥90 morphine milligram equivalents (MME)/day or long-acting opioids. We assessed the association of care setting and specialty with these outcomes.

Results: Among 124,515 patients, 36,716 (29.5%) were opioid-naive. The median opioid supply duration was 3 days (IQR 2-5), the median dose was 50 MME/day (IQR 30-75). Prescriptions for >7 days, ≥90 MME/day or involving long-acting opioids were filled by 10.9%, 20.2% and 0.7% of the patients, respectively. Hydromorphone (50%) and codeine (26.4%) were the most filled opioids. The emergency care setting had double the odds of filling >7 days' supply (OR 2.13, 95% CI 1.99-2.28), and 69% lower chance of filling ≥90 MME/day (OR 0.31, 95% CI 0.29-0.33) than surgical care. In the surgical care setting, there was significant variation across medical specialties. Otolaryngology was associated with a higher chance of prescribing >7 days' opioid supply than general surgery (OR 4.89, 95% CI 3.86-6.20). Orthopaedic surgery had a higher likelihood of ≥90 MME/day prescriptions (OR 2.92, 95% CI 2.58-3.30) than general surgery.

Discussion and conclusions: Opioid prescribing patterns vary significantly by setting and specialty in Nova Scotia, Canada. Our results emphasise the need for tailored guidelines that consider clinical context and specialty to enhance patient safety and reduce opioid misuse risk.