An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures

Justin M. McLawhorn; Matthew P. Stephany; William E. Bruhn; Lauren D. Crow; Brett M. Coldiron; George J. Hruza; Brian C. Leach; Seaver L. Soon; Daniel P. Friedmann; William G. Stebbins; Travis W. Blalock; Michael S. Graves; Elizabeth M. Billingsley; Thomas J. Knackstedt; Stanley J. Miller; Edward H. Yob; John G. Albertini; Nathalie Zeitouni; Richard A. Krathen; Christopher K. Bichakjian; Nathaniel J. Jellinek; C. William Hanke; Faramarz H. Samie; Margaret W. Mann; John A. Carucci; Rohit Kakar; Drew K. Saylor; Scott W. Fosko; Arisa E. Ortiz; William B. Henghold; Thomas A. Jennings; Di Anne S. Davis; Mary E. Maloney; Natalie M. Curcio; Ramona Behshad; Whitney D. Tope; Holly McCoppin; Jarad I. Levin; Lindsey Collins; Thomas Stasko

doi:10.1016/j.jaad.2019.09.080

An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures

Justin M. McLawhorn, Matthew P. Stephany, William E. Bruhn, Lauren D. Crow, Brett M. Coldiron, George J. Hruza, Brian C. Leach, Seaver L. Soon, Daniel P. Friedmann, William G. Stebbins, Travis W. Blalock, Michael S. Graves, Elizabeth M. Billingsley, Thomas J. Knackstedt, Stanley J. Miller, Edward H. Yob, John G. Albertini, Nathalie Zeitouni, Richard A. Krathen, Christopher K. BichakjianNathaniel J. Jellinek, C. William Hanke, Faramarz H. Samie, Margaret W. Mann, John A. Carucci, Rohit Kakar, Drew K. Saylor, Scott W. Fosko, Arisa E. Ortiz, William B. Henghold, Thomas A. Jennings, Di Anne S. Davis, Mary E. Maloney, Natalie M. Curcio, Ramona Behshad, Whitney D. Tope, Holly McCoppin, Jarad I. Levin, Lindsey Collins, Thomas Stasko

Dermatology

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. Objective: To create opioid-prescribing consensus guidelines for common dermatologic procedures. Methods: We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. Results: Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. Limitations: These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. Conclusions: Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

Original language	English (US)
Pages (from-to)	700-708
Number of pages	9
Journal	Journal of the American Academy of Dermatology
Volume	82
Issue number	3
DOIs	https://doi.org/10.1016/j.jaad.2019.09.080
State	Published - Mar 2020

Keywords

Mohs micrographic surgery
cosmetic dermatology
dermatologic surgery
opioid guidelines
opioid overuse
pain management
postoperative pain
public health

ASJC Scopus subject areas

Dermatology

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10.1016/j.jaad.2019.09.080

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McLawhorn, J. M., Stephany, M. P., Bruhn, W. E., Crow, L. D., Coldiron, B. M., Hruza, G. J., Leach, B. C., Soon, S. L., Friedmann, D. P., Stebbins, W. G., Blalock, T. W., Graves, M. S., Billingsley, E. M., Knackstedt, T. J., Miller, S. J., Yob, E. H., Albertini, J. G., Zeitouni, N., Krathen, R. A., ... Stasko, T. (2020). An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures. Journal of the American Academy of Dermatology, 82(3), 700-708. https://doi.org/10.1016/j.jaad.2019.09.080

McLawhorn, JM, Stephany, MP, Bruhn, WE, Crow, LD, Coldiron, BM, Hruza, GJ, Leach, BC, Soon, SL, Friedmann, DP, Stebbins, WG, Blalock, TW, Graves, MS, Billingsley, EM, Knackstedt, TJ, Miller, SJ, Yob, EH, Albertini, JG, Zeitouni, N, Krathen, RA, Bichakjian, CK, Jellinek, NJ, Hanke, CW, Samie, FH, Mann, MW, Carucci, JA, Kakar, R, Saylor, DK, Fosko, SW, Ortiz, AE, Henghold, WB, Jennings, TA, Davis, DAS, Maloney, ME, Curcio, NM, Behshad, R, Tope, WD, McCoppin, H, Levin, JI, Collins, L & Stasko, T 2020, 'An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures', Journal of the American Academy of Dermatology, vol. 82, no. 3, pp. 700-708. https://doi.org/10.1016/j.jaad.2019.09.080

@article{660ee581b5c2471696f205a1c96fa0b1,

title = "An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures",

abstract = "Background: Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. Objective: To create opioid-prescribing consensus guidelines for common dermatologic procedures. Methods: We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. Results: Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. Limitations: These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. Conclusions: Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.",

keywords = "Mohs micrographic surgery, cosmetic dermatology, dermatologic surgery, opioid guidelines, opioid overuse, pain management, postoperative pain, public health",

author = "McLawhorn, {Justin M.} and Stephany, {Matthew P.} and Bruhn, {William E.} and Crow, {Lauren D.} and Coldiron, {Brett M.} and Hruza, {George J.} and Leach, {Brian C.} and Soon, {Seaver L.} and Friedmann, {Daniel P.} and Stebbins, {William G.} and Blalock, {Travis W.} and Graves, {Michael S.} and Billingsley, {Elizabeth M.} and Knackstedt, {Thomas J.} and Miller, {Stanley J.} and Yob, {Edward H.} and Albertini, {John G.} and Nathalie Zeitouni and Krathen, {Richard A.} and Bichakjian, {Christopher K.} and Jellinek, {Nathaniel J.} and Hanke, {C. William} and Samie, {Faramarz H.} and Mann, {Margaret W.} and Carucci, {John A.} and Rohit Kakar and Saylor, {Drew K.} and Fosko, {Scott W.} and Ortiz, {Arisa E.} and Henghold, {William B.} and Jennings, {Thomas A.} and Davis, {Di Anne S.} and Maloney, {Mary E.} and Curcio, {Natalie M.} and Ramona Behshad and Tope, {Whitney D.} and Holly McCoppin and Levin, {Jarad I.} and Lindsey Collins and Thomas Stasko",

note = "Publisher Copyright: {\textcopyright} 2019 American Academy of Dermatology, Inc.",

year = "2020",

month = mar,

doi = "10.1016/j.jaad.2019.09.080",

language = "English (US)",

volume = "82",

pages = "700--708",

journal = "Journal of the American Academy of Dermatology",

issn = "0190-9622",

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number = "3",

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TY - JOUR

T1 - An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures

AU - McLawhorn, Justin M.

AU - Stephany, Matthew P.

AU - Bruhn, William E.

AU - Crow, Lauren D.

AU - Coldiron, Brett M.

AU - Hruza, George J.

AU - Leach, Brian C.

AU - Soon, Seaver L.

AU - Friedmann, Daniel P.

AU - Stebbins, William G.

AU - Blalock, Travis W.

AU - Graves, Michael S.

AU - Billingsley, Elizabeth M.

AU - Knackstedt, Thomas J.

AU - Miller, Stanley J.

AU - Yob, Edward H.

AU - Albertini, John G.

AU - Zeitouni, Nathalie

AU - Krathen, Richard A.

AU - Bichakjian, Christopher K.

AU - Jellinek, Nathaniel J.

AU - Hanke, C. William

AU - Samie, Faramarz H.

AU - Mann, Margaret W.

AU - Carucci, John A.

AU - Kakar, Rohit

AU - Saylor, Drew K.

AU - Fosko, Scott W.

AU - Ortiz, Arisa E.

AU - Henghold, William B.

AU - Jennings, Thomas A.

AU - Davis, Di Anne S.

AU - Maloney, Mary E.

AU - Curcio, Natalie M.

AU - Behshad, Ramona

AU - Tope, Whitney D.

AU - McCoppin, Holly

AU - Levin, Jarad I.

AU - Collins, Lindsey

AU - Stasko, Thomas

PY - 2020/3

Y1 - 2020/3

N2 - Background: Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. Objective: To create opioid-prescribing consensus guidelines for common dermatologic procedures. Methods: We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. Results: Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. Limitations: These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. Conclusions: Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

AB - Background: Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. Objective: To create opioid-prescribing consensus guidelines for common dermatologic procedures. Methods: We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. Results: Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. Limitations: These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. Conclusions: Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

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KW - cosmetic dermatology

KW - dermatologic surgery

KW - opioid guidelines

KW - opioid overuse

KW - pain management

KW - postoperative pain

KW - public health

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ER -

An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures

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