Home E-Weekly April 4, 2017

Are Surgeons Contributing to the Opioid Crisis?

Published: April 3, 2017

NO EXCESS Taking steps to prescribe controlled substances electronically may help to stem the flow of excess opioids.

Surgeons who over-prescribe opioids to help patients manage their post-operative pain may be unwittingly "fueling addiction and death by overdose," says Atul A. Gawande, MD, MPH, the notable surgeon and bestselling author. He says surgeons have a responsibility to combat the opioid crisis and should take advantage of electronic prescribing to limit use of the powerful painkillers.

In 2015, U.S. deaths from drug overdose exceeded 50,000 — 30,000 of which involved opioids, Dr. Gawande writes in The Annals of Surgery. In fact, opioid overdose has surpassed motor-vehicle accidents in terms of U.S. lives claimed each year. Dr. Gawande, a surgeon at Brigham and Women's Hospital and professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School, says surgeons bear some the responsibility.

He cites sobering data linking surgeons with the oversupply of opioids feeding the current epidemic: As much as 10% of opioid-naive patients who receive opioid prescriptions for low-risk surgery continue to take the drugs up to a year later; 72% of narcotics prescribed for 5 common outpatient procedures go unused, opening the door for diversion; and the rates of post-operative opioid over-dosage among patients undergoing inpatient surgery doubled over the last decade.

As a result, Dr. Gawande says surgeons have a duty "to help stem the tide" of drug overdose deaths. His primary suggestion: Adopt the electronic prescribing of controlled substances, which the U.S. Drug Enforcement Agency has been permitting since 2010. Electronic prescribing would make it easier for surgeons to write smaller prescriptions that meet the pain management needs of as much as 80% of patients, because surgeons would have the confidence to know they could quickly and remotely order additional supplies as needed. It would also prevent duplicate and forged prescriptions, reduce dosing errors and cross-reference prescriptions in drug-monitoring databases.

Aside from embracing electronic prescribing, Dr. Gawande advises surgeons to adopt the following pain management protocols:

  • Counsel patients to expect adequate, but not complete pain control;
  • use non-opioid alternatives for patients undergoing procedures expected to cause mild pain;
  • check state prescription monitoring program databases to confirm that patients are not receiving opioids through other clinicians;
  • provide clear disposal instructions for unused opioids; and
  • prescribe the "minimum quantity necessary" to manage post-op pain.

Dr. Gawande says surgeons must take action now to stem the oversupply of opioids. He urges support for wider efforts to improve prescribing methods and encourages data collection to determine which practices are most effective in managing post-op pain with limited use of opioids.

Bill Donahue

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