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Archive Anesthesia 2018

On Point

Help Solve the Opioid Crisis

David Dickerson

David Dickerson, MD


duly noted
DULY NOTED Policies and procedures that outline multimodal pain management techniques create a culture of awareness about limiting opioid use.

Even a minor surgical procedure can trigger a major opioid addiction, a fact made all the more unsettling when you consider that each year an estimated 40% of U.S. pain medication prescriptions are written for post-surgical patients. What can you do to nip a drug problem in the bud? Keep these steps in mind with each patient that passes through your ORs.

1. Put it in writing. Change the post-op pain control culture by including opioid-sparing anesthetic techniques and enhanced recovery pathways in your facility's policies and procedures. Would you let surgeons operate in your ORs without being credentialed? Would you keep nurses on staff who don't meet continuing education requirements? Of course not. So why should you let anesthesia providers and surgeons care for patients if they don't practice what your policies and procedures preach?

2. Take back the excess. You can limit the unused opioids that patients store in medicine cabinets, only to wind up in someone else's hands. It's difficult to change the prescribing habits of your providers overnight, but you can inform patients about how to safely dispose of the excess pills they end up not needing. The outpatient pharmacy that sits a floor below my health system's surgery center installed a DEA-approved 38-gallon medication disposal box. The labels on every bottle of opioids we prescribe at the surgery center include a "Take Back" directive. Patients receive a single sheet that includes bulleted information about the opioid epidemic and the location of the medication drop box. We've collected more than a ton of medications, so it's safe to say the program is working. It wouldn't be difficult to give your patients information about how to safely store opioids and locations in your community where they can dispose of unused pills.

Even seemingly minor procedures can result in major addiction.

3. Monitor usage. Track procedure-specific quantities of opioids used at your facility. (Researchers at the Michigan Opioid Prescribing Engagement Network have developed an excellent resource for right-sizing opioid use based on procedure type: Look for outliers among your surgeons and anesthesia providers and ask them why their lap chole patients, for example, are prescribed twice as many opioids as patients cared for by other physicians. The issue is often a matter of being unaware that they're prescribing more opioids, and peer comparison can be a powerful and informative way to change prescribing behavior.

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