Preventing Unnecessary Exposure to Opioids After Surgery

It’s nearly impossible to pick up a newspaper or scroll through Twitter without coming across a story about the misuse of and addiction to opioids.  These include prescription pain relievers, heroin, and synthetic opioids such as fentanyl. With 130 people dying of an overdose every day, it has become our country’s greatest health crisis since the AIDS epidemic of the 80s and 90s…an epidemic that can affect anyone regardless of age, culture, education or socio-economic status. More than 650,000 opioid prescriptions are dispensed on an average day, according to the U.S. Department of Health and Human Services. While it seems like a stretch to link legitimate pain treatment to opioid addiction, evidence is clear that dependence often begins with the first prescription to manage acute postoperative pain.

One question remains constant:  

How can we effectively treat pain, while reducing the ever-increasing numbers of opioid prescriptions flowing into U.S. homes?  The answer: eliminate or significantly reduce the need for opioids from the time that the pain occurs and when the first prescription is written.

In a March 2017 report, the U.S. Centers for Disease Control and Prevention stated the obvious: "long-term opioid use often begins with treatment of acute pain." They studied the records of more than 1.2 million Americans who received at least one opioid prescription between 2006 and 2015. The findings were stunning:

• If 100 patients are given a prescription for one day’s supply of opioids, six were still using opioids a year later
• If doctors issued a week’s supply, 13 in 100 continued opioid use a year later
• If patients receive a prescription for more than a month, 30 out of 100 became addicted

It’s clear from this data that a new approach to acute pain management is needed – one that prioritizes treatment modalities centered around non-opioid modalities versus those centered on opioids. Simply put, we must get ahead of the problem before it begins.

An excellent place to start is in the postoperative setting. There are 50 million surgeries performed annually in the United States that require postoperative pain management.  More than 90 percent of patients who undergo major surgery are treated with opioid analgesics.  Better non-opioid acute pain management options, including longer acting local anesthetics that address both pain and inflammation at the surgical site and are proven to work during the time acute postoperative pain is most severe (the first 72 hours), will help reduce the need for patient exposure to opioids in the first place. A recent study published in the Annals of Surgery suggests that such a strategy could reduce the need for opioid painkillers by 50%. This alone could stop the flow of hundreds of millions of opioid pills into society each year. 

While leadership and continued efforts to treat opioid addiction across government agencies are necessary and needed, prevention is the superior solution. Substituting a potentially addictive treatment with effective non-opioid options in the surgical setting at the time that pain begins should be considered a clear starting point for change. It’s only through these innovative preventive approaches to safe patient care that we can start to reduce the societal risks associated with opioid overuse. 

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