Surgeons across the nation are increasing efforts to reduce their overall use of opioids for the long term treatment of chronic pain post-operatively. The driving force- Curtailing the opioid abuse epidemic, an unfortunate but growing trend.

Well-Documented Risks
An epidemic effecting 5 million Americans, half of all opioid-related overdose deaths in the U.S. have been linked to prescription drugs – not “street” or “recreational” drugs. Opioid use, even short term, is particularly problematic for patients with a history of substance abuse.

Changing Practices
Seeing the effects of this epidemic, many surgeons are taking steps to better help patients manage the healing process without potentiating future substance abuse issues. To that end, treatment strategies have emerged to reduce patient reliance on opioids postoperatively. Some of these methods include:

  • A reduction in the use of opioids for the short-term management, including the time period two to three days post-op, to prevent the potential for abuse and misuse.
  • Pre and perioperative treatment strategies designed to reduce patient reliance on opioids for moderate to severe post-op pain (commonly the first line of therapy).
  • The implementation of patient pain contracts to engage patients in their own care and formally educate them on pain management, compliance, prescription use, and routine drug monitoring.
  • ERAS (enhanced recovery after surgery) protocol, incorporating the use of short-acting anesthetics, nonsteroidal anti-inflammatory drugs (Exparel, Pacira), ileus control, invasive monitoring, and intensive care treatment combined with minimally invasive surgical techniques designed to enhance post-op recovery by preventing problems resulting from exaggerated inflammatory reactions to procedures (poor healing, infections, organ dysfunction). This technique has been associated with an improved postoperative length of stay and morbidity and reduced reliance on opioids post-operatively.

A Study in Possibilities
A recent study shows how even simple changes may affect opioid use. In the study, a pink reminder card was included in patient files to encourage hand surgeons to discuss with patients prior to surgery postoperative pain management options, explain the risk of opioids, and recommend alternatives. The card – and subsequent discussions – netted a 15% decrease in opioid prescriptions written. Likewise, a survey of dermatologic surgeons found 64% of surgeons prescribing opioids post-operatively for fewer than 10% of surgical patients.

Looking Ahead
While this is a good place to start in the fight against opioid epidemic, when it comes to chronic pain and workers compensation claims, a true drug utilization review program can also contribute to enhancing the quality of treatment and reducing medical costs. ANS Solutions drug utilization review program through pharmacotherapy review is the most advanced of its kind. To find out more about our effective medical cost containment strategies contact us today.

 

References

Dunleavy, Brian. Curbing Opioids Postoperatively, an Increasing Focus of Many Surgeons. PainMedicineNews.com; November 26, 2015.