Changes in Total Opioid Use After Awake Craniotomy After Florida’s Restriction Law for Pain Prescription

Introduction: Multiple federal and state-wide efforts have been pursued to limit opioid prescription in the treatment of acute pain in an effort to address the opioid epidemic. The Florida House Bill 21 (HB21) passed on July 1, 2018 limited the day’s supply of Schedule II opioids to 3 days for acute pain prescriptions, with possible exceptions for 7 days extensions. Here, we aimed to review its impact on the opioid use after awake craniotomy at our institution.

Methods: A retrospective cohort review was completed on patients undergoing awake craniotomy between January 2016 and January 2022 at a tertiary academic center in Florida. Patient’s records were reviewed for demographic, clinical, and outcomes data. Opioid use following awake craniotomy before and after implementation of HB21 was evaluated in terms of morphine equivalent units.

Results: A total of 172 patients undergoing awake craniotomy were included, with 50 patients being operated before HB21 was introduced. Simple regression models showed opioid use after HB21 (average 180.2 morphine equivalent units) to be significantly lower, when compared with initial cases with an average reduction of 69.74 morphine equivalent units (95% confidence interval [CI]= -102.72; -32.76; p=0.036; adjusted r2=0.021). Multiple linear regression models adjusted for patients’ age, gender and BMI showcased significant reduction after HB21 with adjusted r2=0.059. Time to opioid (p=0.238) or 30-day re-admission rate (0.273) was not significantly affected by HB21.

Conclusion : This study suggests that HB21 led to a significant reduction in opioid prescriptions for acute management of post-operative pain following awake craniotomy. Subsequent efforts should be aimed at evaluating potential reductions across other Florida institutions and at developing federal efforts across surgical specialties to achieve similar reductions.