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News — A recent study conducted across nine Iowa hospitals has shown promising results in reducing postoperative opioid prescriptions by implementing Enhanced Recovery After Surgery (ERAS) pathways.

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 to patients undergoing arthroplasty (joint replacement surgery) and arthroscopy (a minimally invasive procedure to diagnose and treat joint issues). Arthroplasty involves replacing damaged joints with prosthetic implants to relieve pain and restore function, whereas arthroscopy utilizes a small camera to examine and repair joint damage through small incisions.

“By leveraging ERAS pathways, which emphasize preoperative education, non-opioid pain management, and less invasive techniques, we found a significant decrease in opioid prescriptions,” 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.  

 Arthroplasty patients experienced a 47% reduction, while arthroscopy patients saw a 33% decrease. Notably, arthroscopy patients had a higher percentage of unused opioids, highlighting the need for tailored strategies to minimize leftover medications.

 ERAS pathways are part of the "Billion Pill Pledge" program, which aims to reduce unnecessary opioid prescriptions and promote safer pain management practices, helping combat the opioid epidemic. 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.

“By implementing these ERAS pathways, Iowa hospitals have demonstrated their commitment to safer pain management and reducing the risk of opioid misuse,” says Ilyas. “Overall, the Billion Pill pathways show promise as a starting point to reduce excess postoperative opioid prescribing across orthopaedics surgeries with the continued need for future studies.”

The study, "Enhanced Recovery After Surgery for Arthroscopy versus Arthroplasty—a Cross-Procedure Comparison of Postoperative Opioid Prescriptions in Orthopaedic Surgery," was recently presented at the 2025 American Academy of Orthopaedic Surgeons Annual Meeting in San Diego and in the Journal of the American Academy of Orthopaedic Surgeons.  A copy is found online at 

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; Dr. Terence L. Thomas of the Rothman Orthopaedic Institute; Wali Pirzada and Sina Ramtin, MD, Research Fellows at the Rothman Opioid Foundation; Simran Shamith and Thalia Le 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 evidenced-based pain management strategies while working to mitigate opioid abuse and addiction.