Physicians Cut Opioid Rx by a Third Without Increasing Pain Levels

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Doctors were able to cut the number of opioids they gave to people postsurgery by nearly a third. Getty Images
  • Prescriptions for fewer opioids don’t leave patients in more pain after surgery, according to a new study.
  • Cutting prescriptions may help stem rising numbers of opioid misuse.
  • Health providers were able to cut opioid prescriptions simply by following new guidelines.

Doctors never want to see their patients suffer. But with the opioid epidemic leading to more than 130 deaths from overdoses every day, they’re facing pressure to cut back on prescriptions for opioids, even after painful procedures like surgery.

Now, a new research letter in The New England Journal of Medicine found a way to discuss how to help patients stay pain-free and off of opioids.

In the article, the authors reported that Michigan surgeons were able to prescribe fewer opioids without increasing patients’ pain during recovery, potentially curbing the risk of long-term dependence.

In the research letter, published online August 14, researchers looked at prescription data from 11,716 patients in 43 hospitals across Michigan.

In 2017, the University of Michigan developed new opioid prescribing recommendations for a variety of common surgeries to help doctors ease acute pain while limiting the risk of developing a dependence. These guidelines were used in the letter published on August 14, and have since been revised to recommend even smaller prescriptions.

They found that from February 2017 to May 2018, the surgical teams were able to reduce the amount of opioids prescribed to patients after nine common operations from an average of 26 pills to 18 pills each.

Furthermore, patients only took about half the pain pills prescribed to them.

The researchers also looked at data from 6,585 patients who responded to surveys and found that those who took fewer pain pills didn’t experience greater levels of pain than those who took more opioids.

“There’s lots of evidence that shows you can use things like nonsteroidal anti-inflammatories (NSAIDs) [like aspirin and ibuprofen], Tylenol, and longer-acting local anesthetics instead of opioids after surgery,” said Dr. Mark L. Smith, vice chair of the Department of Surgery at Northwell Health, and director of reconstructive oncology at Northwell Health Cancer Institute.

“I’d expect that if doctors use a full array of modalities, they can reduce the rate of prescribing opioids even more. This is a start,” he added.

Surgery is often one of the first times someone is exposed to opioids.

Research shows that around 6 percent of people who had no history of opioid use in the year prior to a surgery became persistent users of pain medications 3–6 months after the procedure.

Doctors have been under increased scrutiny to curb the amount of opioids they’re prescribing while still minimizing the amount of pain that patients experience.

“When pain became the fifth vital sign in 2001, anyone with pain could get pain medication to their liking, rather than an appropriate amount based on science, experience, and a complete understanding of the medication,” said Dr. Rafath Baig, a spine surgeon at Desert Spine and Scoliosis Center.

“Now with the opioid epidemic, we are under pressure to be more judicious in prescribing pain medication,” he said.

Doctors are increasingly cutting back on the number of opioids they prescribe. A 2018 survey of 8,774 physicians found that 69 percent of doctors are prescribing fewer opioids than in previous years.

“I let my patients know that their success is my success. I didn’t sacrifice the better part of my life to prescribe pain medications and watch my patients’ lives go down the drain [from an addiction],” said Baig, who has a strict no-refill policy for opioids.

Doctors also say that taking a “Disease Control and Prevention (CDC)” rationale=”Governmental authority”>multimodal approach” to pain relief can decrease the need for opioids without making patients more uncomfortable after surgery.

While that may include some opioids, it also relies on other treatments like acetaminophen, NSAIDs, muscle relaxants, local anesthesia, antidepressants, cognitive behavioral therapy, and physical therapy to ease pain.

“A lot of surgeons write a script for 30 tablets and may even write a refill. That’s a big part of overprescribing, so having recommendations for lower amounts with follow-ups prior to additional dosing is a more pragmatic way to go,” said Smith.

“If we get ahead of the pain and nip it in the bud with things on the local level, we can decrease the amount of opioid medications a patient needs,” said Baig.

Researchers in the Michigan study also credit the reduction in opioid use to presurgical counseling, during which doctors speak with patients about pain expectations, appropriate use of pain medications, and the potential dangers of opioid use.

“Depending on the procedure, I tell patients you’re going to have significant pain for two days, but if you can get through it, you’ll be fine,” said Dr. Bradford Tucker, assistant orthopedic surgeon for the Philadelphia Phillies and Philadelphia 76ers, who has decreased his opioid prescriptions by more than 80 percent.

“I remind them that pain can’t harm or kill you, but narcotics can,” he said. “The pressure doctors are under to give less narcotics is only a good thing.”

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