News — (Philadelphia, PA) A recent study conducted across nine Iowa hospitals has shown promising results in reducing postoperative opioid prescriptions through the implementation of Enhanced Recovery After Surgery (ERAS) protocols, part of the "Billion Pill Pledge" program. The study, which analyzed data from patients undergoing orthopaedic and general surgeries, highlights the effectiveness of these protocols in minimizing opioid use while maintaining effective pain management.
The study, led by researchers from the Rothman Opioid Foundation, Goldfinch Health, and Drexel University College of Medicine, examined the impact of ERAS protocols on opioid prescribing practices across different surgical specialties. By analyzing data from 180 patients, the researchers found a significant decrease in opioid prescriptions post-ERAS implementation. Across all surgeries, the mean opioid prescription decreased from 341 morphine milligram equivalents (MMEs) to 151 MMEs, representing a 43% reduction in opioid use.
“Overall, the ‘Billion Pill Pledge’ ERAS program demonstrates promise for reducing postoperative opioid use, highlighting the need for continued refinement and expansion into other regions and surgical specialties,” says Dr. Asif Ilyas, co-author of the study and President of the Rothman Institute Foundation for Opioid Research & Education and Professor of Orthopaedic Surgery at Drexel University College of Medicine. In 2022, Iowa became the first state to launch the Billion Pill Pledge program, an opioid first-dose prevention strategy led by Goldfinch Health. The Billion Pill Pledge program reduces unnecessary prescription opioid pills after surgery. This results in a lower risk of addiction, diversion, and accidental overdoses.
“The success of the ‘Billion Pill Pledge’ ERAS protocols in Iowa hospitals underscores the potential for these strategies to combat the opioid epidemic by reducing unnecessary opioid prescriptions and promoting safer pain management practices,” says Ilyas.Orthopaedic surgery patients experienced a more pronounced reduction, with a mean decrease of 45% in opioid prescriptions, from 462 MMEs to 197 MMEs. General surgery patients saw a 38% decrease, from 100 MMEs to 60 MMEs. Despite these reductions, both groups reported substantial amounts of unused opioids, emphasizing the need for targeted strategies to minimize leftover medications.“As the opioid crisis continues to affect communities nationwide, initiatives like this demonstrate the importance of collaborative efforts between healthcare providers and community organizations in addressing public health challenges,” says Ilyas.
The study's findings support the expansion of ERAS protocols to other surgical specialties and emphasize the need for continued research into optimizing opioid prescription practices. By focusing on the disposal of unused opioids and tailoring protocols to specific surgical procedures, healthcare providers can further reduce the risk of opioid misuse and diversion.
The study, Utility of Enhanced Recovery After Surgery Protocols in Reducing Postoperative Opioid Use Across Different Surgical Specialties—An Analysis of Iowa’s Billion Pill Pledge Program, was recently presented at the 2025 American Academy of Orthopaedic Surgeons Annual Meeting in San Diego and published in the Journal of the American Academy of Orthopaedic Surgeons. A copy of the study is found online at https://pubmed.ncbi.nlm.nih.gov/40127220/The research was conducted by Dr. Asif Ilyas, President of the Rothman Institute Foundation for Opioid Research & Education and Professor of Orthopaedic Surgery at Drexel University College of Medicine, Wali Pirzada and Sina Ramtin, MD, Research Fellows at the Rothman Opioid Foundation, and Simran Shamith, Sara Khan, and Rolan Leyson of Drexel University College of Medicine.
About the Rothman Institute Foundation for Opioid Research and Education.
The Rothman Opioid Foundation, for short, is a non-profit 501c3 organization dedicated to raising awareness of the ongoing opioid crisis, educating physicians and patients on safe opioid prescribing and use – respectively, and advising policymakers on sound opioid and pain management policy. Most importantly, the Rothman Opioid Foundation performs and supports the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidence-based pain management strategies while working to mitigate opioid abuse and addiction. https://www.rothmanopioid.org/
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