TOFAS for Providers

Overdose Facts

In 2021, 98,268 drug-related overdose deaths occurred in the United States. Of those, 78%, or 75,785 deaths, were due to an opioid overdose. That’s 208 individuals dying each day in the U.S. due to an opioid overdose 1

Ohio has the 6th highest drug overdose mortality rate in the country, at 48.1 deaths per 100,000 population behind West Virginia (90.9), Tennessee (56.6), Louisiana (55.9), Kentucky (55.6) and New Mexico (51.6). 1

In Franklin County, 752 individuals died from a drug overdose in 2022, up from 547 (a 37% increase) in 2019, the year before the COVID pandemic.3

A 2009 study of young, urban injection drug users found that 86% had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions. 4


Reducing Opioid Use After Ambulatory Surgery: A Collaborative Approach

Unused opioids prescribed for postoperative pain control after elective surgery remain an underrecognized contributor to the opioid abuse epidemic. A quality improvement project, being undertaken by OhioHealth, Mount Carmel Health System, Nationwide Children’s Hospital, and The Ohio State University Wexner Medical Center,  aims to characterize and reduce opioid use after elective ambulatory surgery across the health systems in Central Ohio.

Toward Opioid-Free Ambulatory Surgery (TOFAS) is an initiative, originating at the OSU Wexner Medical Center, to investigate the effectiveness of pain management with minimal use of opioids for same-day or ambulatory surgery patients.

Project goal: Reduce the prescribing of opioids after surgery, while maintaining pain management through the recovery process.

Methods: Patients undergoing elective, ambulatory surgical procedures will be identified by each of the 4 hospital systems on a monthly basis.  Service lines will include General Surgery, Gynecology, Urology, ENT, and Orthopedic Surgery. Patients will be engaged via MyChart, email and/or telephone call after surgery to determine details about postoperative analgesic medications including opioids prescribed, opioids used and opioids remaining unused, including how they were disposed. Results will be shared with the prescribing providers.


Shared Learnings from OSU Wexner

The TOFAS initiative across the four Central Ohio hospital systems came about after a similar project was implemented at the Ohio State University Wexner Medical Center. A TOFAS research project was initiated at OSUWMC to create, implement, and evaluate an opioid-sparing analgesic regimen for use in ambulatory surgery.  The regimen included a post-operative prescription of alternating acetaminophen and ibuprofen for 3 days following surgery, along with a rescue prescription of Oxycodone for breakthrough pain, in needed by the patient.

Results of the study showed:

  • 90% of patients enrolled participated
  • 58% of patients did not use their opioid rescue prescription
  • Of the 42% who used their rescue prescription, a median of 3 out of 10 pills were used
  • Pain management was still effective despite the opioid reducing regimen (mean preop pain score 1.28 [on 1-10 scale with 0 being no pain and 10 being worst pain] versus mean postop score of 1.50)



  1. Center for Disease Control and Prevention, National Center for Health Statistics
  2. City of Columbus, Columbus and Franklin County Addiction Plan
  3. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002-2004 and 2008-2010