Archive April 2017 XVIII, No. 4

Are Surgeons Fueling the Opioid Epidemic?

If surgeons are "unwittingly enablers of addiction, abuse and overdosage," how should they manage post-op pain?

Daniel Cook, Executive Editor

opioids

It is a stinging indictment by one of healthcare's leading voices: Surgeons have contributed to the nation's opioid epidemic by overprescribing opioids for post-operative pain relief. "Surgeons are unwittingly enablers of addiction, abuse and overdosage," says surgeon, writer and public health researcher Atul A. Gawande, MD, MPH, of Harvard Medical School, in this month's Annals of Surgery (osmag.net/CVjo4H).

Dr. Gawande theorizes that surgeons frequently supply patients with a large excess of painkillers so they don't strand them with an insufficient supply of pills for their pain and no straightforward way to get a refill without a written prescription. "We surgeons turn out to be suppliers of the excess prescription opiates fueling addiction and death by overdose," writes Dr. Gawande. "We have to change that."

With that as a backdrop, we asked several physicians about the impact, both positive and negative, the opioid epidemic is having on their efforts to manage post-op pain.

"It's encouraged providers to set up clinical pathways that closely examine how much multimodal analgesia can be applied to different procedures in order to minimize the use of opioids," says Daniel Carr, MD, MA, program director of pain, research education and policy at Tufts University School of Medicine in Boston, Mass. "On the other hand, the stigma of opioid use can keep the effective pain therapy from innocent surgical patients who could truly benefit from it."

A positive development from the opioid epidemic, our experts say, is that more and more surgeons are prescribing the "minimum quantity necessary," writing for 15 opioid pills rather than 50 after a lap chole or inguinal hernia, for example. The benefits of adjusting discharge prescriptions to be more consistent with the number of pills patients actually need are twofold. There's less chance of the patient becoming dependent and of unused pills getting diverted.

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