ATTITUDES AND PRACTICES SURROUNDING OPIOID PRESCRIPTIONS FOLLOWING OPEN REDUCTION INTERNAL FIXATION OF DISTAL RADIUS AND ANKLE FRACTURES: A SURVEY OF THE CANADIAN ORTHOPAEDIC ASSOCIATION MEMBERSHIP

The past two decades have seen a significant increase in consequences associated with non-medical misuse of prescription opioids, such as addiction and unintentional overdose deaths. The purpose of this study was to design and disseminate an electronic survey to assess attitudes and opioid-prescribing practices of Canadian orthopaedic surgeons and trainees following open reduction internal fixation (ORIF) of distal radius and ankle fractures. This study was first to assess these factors following ORIF of distal radius and ankle fractures using a survey design. A 40-item survey was developed focusing on four themes: Respondent Demographics, Opioid-Prescribing Practice, Patients with Substance Use Disorders, and Drug Diversion. The survey was distributed among members of the Canadian Orthopaedic Association. Descriptive statistics were used to summarize respondent demographics and outcomes of interest. A Chi-square test was used to determine if the proportion of opioid prescriptions between attending surgeons and surgeons in-training was equal. One-hundred and ninety-one surveys were completed. Most respondents prescribed 10-40 tabs of immediate-release opioids, though this number varied considerably. While most respondents believed patients consumed only 40-80% of the prescribed opioids (73.6%), only 28.7% of respondents counselled patients on safe storage/disposal of leftover opioids. Thirty-point-five percent of respondents felt confident in their knowledge of opioid use and mechanisms of addiction. Most respondents desired further education on topics such as procedure-based opioid-prescribing protocols (74.2%), alternative pain management strategies (69.7%), and mechanisms of opioid addiction (49.0%). The principle finding of this study is the apparent lack of a standardized approach to post-operative opioid prescribing in distal radius and ankle fractures, illustrated by the wide range in number of opioids prescribed by Canadian orthopaedic surgeons. Our data suggest a trend towards over-prescription among respondents following distal radius and ankle ORIF, which is similar to the statistics observed among United States orthopaedic surgeons. Future studies should use the trends identified in this study to inform and rationalize interventions targeted at reducing post-operative opioid prescribing for common orthopaedic trauma procedures, especially in Canada where the opioid epidemic continues to worsen.