Patients taking narcotics chronically are more likely to have worse outcomes after total joint arthroplasty. These negative outcomes may be avoided when modifiable risk factors such as narcotic use are identified and improved before elective joint replacement. An accurate assessment of narcotic use is needed to identify patients before surgery. This study examines the amount of reported narcotic use in patients with hip or knee osteoarthritis and compares this with the narcotic prescriptions recorded in our state's drug prescription monitoring database.
All new patients seen during a 1-year period by our adult reconstruction practice were identified. Patients' electronic health records were reviewed to determine whether narcotic use was reported. A subsequent search was performed using the Arkansas Prescription Drug Monitoring Program to determine if the patient had been previously prescribed a narcotic.
A total of 502 patients were included in the study. One hundred seventy patients (34%) were prescribed a narcotic within 3 months of the clinic visit according to the Arkansas Prescription Drug Monitoring Program, but only 111 (22%) reported narcotic use in their electronic health record (P < .0001). Moreover, only 92 patients (54% of 170) prescribed a narcotic within 3 months reported it. Narcotic recipients were more likely to be under the age of 65 years (P = .0081), smokers (P < .0001), and current benzodiazepine users (P < .0001).
This study demonstrates that patients significantly underreport their narcotic use to their physician. The availability of a state prescription drug monitoring program allows physicians to check the frequency of filled narcotic prescriptions by their patients.