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Archive February 2019 XX, No. 2

Throw Away the Script

With opioid-sparing surgery, most patients won't need prescription painkillers.

Scott Sigman

Scott Sigman, MD



Becoming an opioid-sparing surgeon was the most liberating thing I've done in 25 years of practice. Why? Because before I started down this revolutionary path, I'd unwittingly become a pain-management specialist. True, I was an orthopedic surgeon and a healer — what I wanted to be — but I was also writing prescriptions for narcotics. And I was writing refills. And I was spending time trying to wean patients off their medications, because 20% were popping them like Jujubes — very early on showing signs of dependence, abuse and addiction. Plus, I was getting calls at all hours of the day and night, and had to be concerned about patients calling me on weekends.

Not anymore. Now, 5 years later, I'm still a healer of knees and shoulders, left and right, but that's it. Not because I don't care about my patients. I care deeply about them. But because, thankfully, we've figured out how to manage and minimize pain, so that they — and I — no longer have to worry about whether opioids might ruin their lives.

It's important to remember just how this profound and deadly opioid crisis came about — how it is that 4 out of 5 heroin users started with prescriptive opioid medications.

It happened because we succumbed to misinformation and an absurd proposition. The misinformation we were fed was that opioids are inexpensive and non-addictive. Both of those assertions turn out to be patently false. The absurd proposition was that we could and should consider pain a vital sign, and that we had to make sure our patients were completely pain-free. We were told, in fact, we would be graded on our work. Pain would be quantified on a 1 to 10 scale, and if our patients weren't zeros or ones, our hospitals could be penalized and our satisfaction ratings would surely plummet.

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