{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:27:14Z","timestamp":1791581234327,"version":"4.3.4"},"reference-count":45,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Toronto General & Western Hospital Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,10,26]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Increased use of opioids and their associated harms have raised concerns around prescription opioid use for pain management following surgery. We examined trends and patterns of opioid prescribing following elective orthopaedic surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Ontario residents aged 66+ years\u2009who had elective orthopaedic surgery from April 2004 to March 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Postoperative opioid use (short term: within 90 days of surgery, prolonged: within 180 days and chronic: within 1\u2009year), specific opioids prescribed, average duration (days) and amount (morphine milligram equivalents) of the initial prescription by year of surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 464\u2009460 elective orthopaedic surgeries in 2004\/2005\u20132017\/2018: 80% of patients used opioids within 1\u2009year of surgery\u201425.1% were chronic users. There was an 8% increase in opioid use within 1\u2009year of surgery, from 75.1% in 2004\/2005 to 80.9% in 2017\/2018: a 29% increase in short-term use and a decline in prolonged (9%) and chronic (22%) use. After 2014\/2015, prescribed opioid amounts initially declined sharply, while the duration of the initial prescription increased substantially. Across categories of use, there was a steady decline in coprescription of benzodiazepines and opioids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most patients filled opioid prescriptions after surgery, and many continued filling prescriptions after 3\u2009months. During a period of general increase in awareness of opioid harms and dissemination of guidelines\/policies aimed at opioid prescribing for chronic pain, we found changes in prescribing practices following elective orthopaedic surgery. Findings illustrate the potential impact of guidelines\/policies on shaping prescription patterns in the surgical population, even in the absence of specific guidelines for surgical prescribing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-074423","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T12:11:59Z","timestamp":1699963919000},"page":"e074423","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Time trends and patterns in opioid prescription use following orthopaedic surgery in Ontario, Canada, from 2004\/2005 to 2017\/2018: a population-based study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5532-9423","authenticated-orcid":false,"given":"Mayilee","family":"Canizares","sequence":"first","affiliation":[{"name":"Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Denise","family":"Power","sequence":"additional","affiliation":[{"name":"Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony V","family":"Perruccio","sequence":"additional","affiliation":[{"name":"Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Veillette","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizar","family":"Mahomed","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y Raja","family":"Rampersaud","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"2025120519302204000_13.11.e074423.1","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1016\/S0140-6736(19)32229-9","article-title":"Global patterns of opioid use and dependence: harms to populations, interventions, and future action","volume":"394","author":"Degenhardt","year":"2019","journal-title":"Lancet"},{"key":"2025120519302204000_13.11.e074423.2","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-14-90","article-title":"Trends and changes in prescription opioid analgesic dispensing in Canada 2005\u20132012: an update with a focus on recent interventions","volume":"14","author":"Fischer","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2025120519302204000_13.11.e074423.3","first-page":"1257","article-title":"Canadian guideline for safe and effective use of opioids for chronic Noncancer pain: clinical summary for family physicians. part 1: general population","volume":"57","author":"Kahan","year":"2011","journal-title":"Can Fam Physician"},{"key":"2025120519302204000_13.11.e074423.4","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20170104"},{"key":"2025120519302204000_13.11.e074423.5","unstructured":"Narcotic monitoring system (NMS) . 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