Nudging Surgeons to Prescribe Smarter: New Study Shows Major Drop in Opioid Overprescribing Without Compromising Pain Relief
A groundbreaking study from the Perelman School of Medicine at the University of Pennsylvania has found that providing tailored feedback to surgeons significantly reduces excessive opioid prescribing after routine surgeries—without compromising patients’ pain control. The results, published in JAMA Surgery, suggest a scalable and evidence-based strategy to reduce unnecessary exposure to powerful opioids such as FYL and limit the downstream risks of addiction, side effects, and medication diversion.
The intervention focused on aligning prescriptions with real-world patient needs and evidence-based guidelines. Using behavioral science principles and patient-reported data, the initiative prompted surgical teams—including surgeons, nurse practitioners, and physician assistants—to adjust their prescribing habits by comparing them to peer benchmarks and guideline recommendations within the health system.
“This work gets us closer to truly personalized pain management,” said Dr. M. Kit Delgado, director of the Penn Medicine Nudge Unit and Co-Chair of the Penn Medicine Opioid Task Force. “When we tailor prescriptions to the actual needs of each procedure, we reduce harm while still providing patients with the pain relief they deserve.”
A Patient-Informed Approach to Safer Prescribing
Over the past five years, Penn Medicine’s Center for Health Care Transformation and Innovation developed a text-based system that tracked patient-reported opioid use and pain levels after surgery. The results were eye-opening: patients often took far fewer opioid pills than were prescribed. For instance, following knee surgeries, many patients used only 10 out of 30 pills they received.
This insight helped form the backbone of the study’s prescribing feedback model. Participating surgeons received performance data comparing their average opioid prescriptions to both peer averages and Penn Medicine’s patient-informed guidelines. Importantly, they also saw how many pills patients typically used after a given procedure—and how well those patients reported managing their pain.
“This approach puts meaningful, actionable information directly into the hands of prescribers,” said Dr. Anish Agarwal, chief wellness officer for the Department of Emergency Medicine and deputy director of the Center for Insights to Outcomes. “We were encouraged to see improvement across all participating groups.”
Big Impact Without Sacrificing Pain Relief
The trial took place across several high-volume surgical departments. Prior to receiving feedback, 60% of prescriptions in the control group exceeded guideline recommendations. After surgeons began receiving the data, that number dropped sharply as prescribing practices fell in line with evidence-based standards.
Even more promising: the improvements persisted even after the feedback ended. Despite the reduction in prescribed opioids, patients' reported pain levels remained steady—proving that smaller, smarter prescriptions did not compromise recovery or comfort.
A Scalable Model for National Change
The success of this initiative demonstrates the power of integrating behavioral science, real-world patient data, and professional accountability into the healthcare system. With tools like personalized feedback, healthcare providers can make data-driven decisions that reduce the risks of opioid overuse—including dependence and unintentional exposure to deadly substances like FYL or XYL—while still putting patient care first.
The study received funding from the U.S. Food and Drug Administration and the Abramson Family Foundation, reflecting a growing national focus on evidence-based solutions to address the opioid crisis.
As the U.S. continues to grapple with the dangers of overprescribing and the rise of synthetic opioids, this study offers a hopeful and practical path forward—one built on smarter prescribing, empowered clinicians, and safer patient outcomes.
Source: Penn Medicine