Home E-Weekly March 14, 2017

Are You Overprescribing Opioids? Read This

Published: March 13, 2017

NO PAIN The study's authors provided surgeons with "reasonable" guidelines for opioid prescriptions and also recommended advising patients to manage post-operative pain using non-narcotic painkillers.

Are you overprescribing opioids to help patients manage their post-operative pain? If so, the authors of a new study say making surgeons more aware of the issue may help facilities do their part to curb the nation's deadly opioid epidemic.

Educational interventions helped surgeons at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., decrease opioid prescriptions for certain outpatient procedures by more than half, according to the study, which was published in a recent issue of Annals of Surgery. The authors' goal: to prevent the long-term use of opioids by patients and also to block the diversion of these painkillers to illegal users.

When the authors analyzed the medical records of 642 patients who underwent breast surgery, hernia repairs and cholecystectomy in 2015, they found that opioids were greatly overprescribed, with only 28% of the pills being consumed. In May and June 2016, they proposed "reasonable" guidelines to dramatically cut the number of opioids for these procedures, while still satisfying 80% of patients' analgesic requirements. This included the recommendation that surgeons advise patients to manage their pain with non-narcotic painkillers such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAID) like ibuprofen.

In October 2016, the authors identified all Dartmouth-Hitchcock patients who underwent 5 outpatient operations of interest &mash; partial mastectomy, partial mastectomy with a lymph node biopsy, gallbladder removal and 2 different kinds of hernia repair &mash; between June 1, 2016, and Sept. 30, 2016. A follow-up survey of 224 patients showed that the total number of opioids prescribed dropped from 6,170 before the education initiative to 2,932 afterward — a 53% decline. Only one patient requested a prescription refill.

Also, 85% of the post-education patients used either an NSAID or acetaminophen. The authors suggest more patients will not require opioids if given both acetaminophen and an NSAID. Citing the Cochrane Database of Systematic Reviews, the authors found that 200 mg of ibuprofen and 500 mg of acetaminophen relieved pain in 69% of patients, while 400 mg of ibuprofen and 1,000 mg of acetaminophen relieved pain in 73% of patients.

Bill Donahue

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