American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Addressing the opioid crisis, part I

OCTOBER 23, 2017
Clinical Congress Daily Highlights, Monday Second Edition

The misuse of prescription opioids is a public health emergency in the United States, with opioid-related deaths tracking rising prescription rates. An estimated 12.5 million people misused prescription opioids in 2015, including 2.1 million people who did it for the first time, according to the U.S. Department of Health and Human Services. An estimated 33,091 people died from opioid overdose, nearly half of them after using commonly prescribed opioids. 

This crisis has made opioids one of the most discussed topics at the 2017 Clinical Congress. Here is a short synopsis of four studies presented Monday: 

  • “Effect of Opioid Schedule Change on Prescribing Habits of Surgeons,” led by Joe A. Habbouche of the University of Michigan, Ann Arbor, MI, found that recent policy changes to restrict postoperative opioid prescribing actually had the confounding effect of increasing prescription size, essentially reversing prior downward trends in opioid use. The findings highlight the need for policy measures tailored toward surgical care in order to prevent untoward effects of broad restrictions in opioid prescribing. 
  • “Opioids at Discharge: Patient Opioid Use After General and Orthopedic Surgery,” led by Mayo Fujii, MD, of the University of Vermont Medical Center, Burlington, VT, concluded that patients are often prescribed more opioids after surgery than they need, and are seldom told what to do with the unused drugs. Surgical patients typically used only about 26 percent of prescribed medication (typically oxycodone or hydromorphone) and only 21 percent said they received instructions on how to dispose of unused medication. The authors conclude that more effective prescribing could minimize unused opioids in the community. 
  • “Variation in Probability of Post-Operative Opioid Prescription Refilling in the United States,” led by Hannah R. Cottrell of the University of Michigan in Ann Arbor, MI, found that increasing the amount of opioids prescribed after surgery did not lead to a decrease in refill probability. Instead, it was most likely that patients with a history of tobacco use, a mental health disorder, or a pain disorder were more likely to ask for a refill than others. The authors concluded that to avoid refills generally, a minimum of 180 oral morphine equivalents (OMEs), or about 36 pills of 5 mg hydrocodone, should be prescribed — although most patients will use far less. 
  • “Post-Operative Surgical Trainee Opioid Prescribing Practices: An Institutional Study,” led by David J. Hall, III, MD, of the University of Florida, Gainesville, FL, found a wide variability in opioid prescribing practices and attitudes toward pain management among surgical trainees. Of the respondents, 46 percent agreed that they prescribed more opioids than necessary for surgical patients being discharged. The authors concluded that this was because resident physicians rarely receive formal education in effective opioid prescribing practices or pain management. They felt the solution was formal education in pain management and effective prescribing of these medications. 

Additional Information: 
The four Scientific Forum studies presented October 23 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA, were: Effect of Opioid Schedule Change on Prescribing Habits of Surgeons, Opioids at Discharge: Patient Use After General and Orthopaedic Surgery, Variation in Probability of Post-Operative Opioid Prescription Refilling in the United States, and Post-Operative Surgical Trainee Opioids Prescribing Practices. Program, webcast and audio information is available online at FACS.org/clincon2017.

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