Evidence-Based Opioid Education that Reduces Prescribing: The 10 Principles of Opioid Prescribing in Foot and Ankle Surgery.

The United States Opioid Epidemic is a worsening public health crisis. We aim to determine if a voluntary educational intervention containing standard opioid and non-opioid analgesic prescribing ranges for common surgeries is effective in altering postoperative prescribing practice. We utilized a mixed methods approach and sent out a questionnaire to American podiatric physicians, including residents (baseline group A), via email in early 2020 for baseline data; then, we interviewed foot and ankle surgeons and the primary themes of these semi-structured interviews informed us to target residents for an educational intervention. We repeated the survey 3 years later in summer 2022 (pre-intervention group B). We created an opioid guide and emailed it to residents in fall 2022. Another repeat survey was done in spring 2023 (post-intervention group C). We used the Mann-Whitney U test to examine differences between the groups among their reported postoperative opioid quantities for a first metatarsal osteotomy surgical scenario. Groups A, B, and C had 60, 100, and 99 residents, respectively. There was no significant difference (p=0.9873) between baseline group A and pre-intervention group B. There was a difference (p<0.0001; -5 median) between pre-intervention group B and post-intervention group C (same residency year). In post-intervention group C, a majority (91/99) reported viewing the guide at least once, and the number of residents that reported supplementing with NSAIDs also doubled compared to pre-intervention group B. This novel opioid educational intervention resulted in meaningful change in self-reported postoperative prescribing behavior among residents.