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Home E-Weekly December 5, 2017

Could Evidence-Based Prescribing Guidelines Curb the Opioid Epidemic?

Published: December 4, 2017

OVERDOSAGE Using the day before discharge as a marker for how many painkillers a patient needs could help reduce opioid prescriptions.

Some blame surgeons for unwittingly fueling addiction by over-prescribing opioids for post-operative pain, but knowing how many painkillers to prescribe at discharge can be tricky, especially with a growing epidemic. But a new study's guidelines have set out to better draw that line and claim to reduce opioid prescriptions by up to 40%.

By using the amount of pain medication the patient takes the day before discharge as a marker, you can better prescribe the amount she'll need once she gets home, according to a new study published on the Journal of the American College of Surgeons website. That means that depending on how many opioids the patient takes the day before discharge, doctors might not have to prescribe any opioids at all.

Study authors looked at 333 hospital inpatients who were discharged after 6 different general surgery operations, including bariatric procedures, hernia repairs and colon operations. They found that once patients were discharged, they only took a small portion of the opioids prescribed while at home. In fact, 85% of patients were prescribed opioids, but only 38% of those opioids were actually taken.

Researchers then drafted up guidelines for surgeons to follow based on the medications the patient took the day before discharge. Their suggestions? If a patient doesn't take any opioids the day before discharge, they don't need a prescription. If they take 1–3 pills the day before discharge, doctors should send them home with a prescription for 15 pills. And if the patient takes 4 or more pills the day before discharge, they should be given a prescription of 30 opioid pills. This, says researchers, could reduce opioid prescriptions by about 40%. That's because out of all the patients they surveyed, 41% didn't require any opioids the day before discharge.

But that's not the only reason this study proves consequential. "No matter what type of general surgery operation they had, this association held throughout all procedures studied," said lead study author Richard J. Barth Jr., MD, in an American College of Surgeons press release. "So the beauty of this finding is that one guideline would apply for multiple different surgical procedures."

Noting that surgical patients have a higher risk of becoming chronic opioid users than non-surgical patients, Dr. Barth hopes the study can help curb the opioid epidemic.

Brielle Gregory

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