The Opioid Crisis: HMS Responds With Education
Patients Receive More Opioids Than Necessary After Surgery, Study Shows
Overprescription of these powerful, addictive medications is partly fueling the opioid crisis in the United States.
By Nicol Natale
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November 12, 2019
Every single day, more than 115 people die from opioid abuse in the United States, according to the CDC. One of the reasons for this growing epidemic could be doctors overprescribing opioids after surgery, according to new research.
A study published in found that many surgeons are writing prescriptions for opioid painkillers four times larger than what the patient will actually use after surgery. And the more pills a patient is prescribed, the more they will likely take, despite pain scores and the intensity of the surgical procedure.
“It was great to see the results confirming what we had suspected — that if you prescribe more pills to patients, they take more, regardless of their pain or other factors,” says Joceline Vu, MD, senior author of the new paper and a surgical resident and research fellow at Michigan Medicine, U-M’s academic medical center. “This means that pain isn’t the primary driver of how much patients take after surgery.”
Researchers examined data from nearly 2,400 patients who had one of 12 common operations across 33 different hospitals in Michigan in 2019. On average, patients used only 27 percent of the opioids they were prescribed. For every 10 additional pills prescribed, patients were likely to take at least five of them.
“One of the biggest reasons we’re overprescribing, especially after surgery, is because we just don’t really know how many pills patients actually needed,” says Dr. Vu. “Couple that with a desire to satisfy patients and you have an incentive to write more pills just in case they need them.”
The study found that the quantity of opioids prescribed was a bigger predictor of the likelihood to take them than the severity of pain after surgery.
Tobacco users, younger patients, and individuals whose surgery took place in an inpatient setting, as well as individuals with worse underlying health as measured by the American Society of Anesthesiologists classification system, tended to take more opioids after surgery.
Patients who had hernia repair surgery took the most opioids, whereas patients who had surgery to remove the appendix or thyroid used the least.
The researchers noted that they did not have background medical information about patients’ history of mental health or presurgery opioid use data, which, according to Michigan Medicine, is associated with higher rates of prolonged opioid use after surgery.
Despite these limitations, the research in this study shines light on the impact of opioid overprescription, which can inadvertently fuel the greater epidemic of abuse in the United States. Leftover pills can be used in the future, sold, or given away to those who may abuse them.
“Prescription opioids are as addictive as their related drug heroin, and they’re a much easier gateway to addiction and the eventual switch to intravenous drugs,” says Vu.
Changing prescribing habits may shift trends in opioid abuse and work toward reducing the devastating public health crisis that is opioid addiction.
“Simply prescribing less is an easy way to make an impact, especially since we know patients need much less than we give them,” says Vu. “It’s not the only solution though; we do cause legitimate pain when we perform surgery, and we have to make sure we are adequately treating patients’ pain.”
Understanding patient needs after surgery and working toward safer, nonaddictive strategies for managing pain are the keys to effective use of opioids and pain management.
“We should also try to use nonopioid medications as much as possible; often these can be even more effective for pain and they don’t have the same risks of addiction,” says Vu. “We should think of these medications as dangerous substances, and check on our patients. If they’re done taking them, we need to encourage our patients to dispose of them safely and make it easy to do so.”
The best way to throw away excess opioids is to take them to an authorized disposal site, which can be your local police station, hospital, and some pharmacies, Vu says.
Video: Pain patients worry about restricting availability of opioids
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