The opioid epidemic: Surgeon to surgeon

Sunday, July 01, 2018 12:16 PM
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by Bruce Waring, MD, FACS, Surgical Specialists of Colorado, Partner

Surgeons can play an important role in addressing the national opioid crisis. First, we must accept some of the responsibility, as 37 percent of all opioid prescriptions are written by surgeons. Recent studies indicate that 6 percent of general surgery patients will be taking an opioid for a reason other than their surgery one year after their procedure. The number increases to 14 percent for patients at the one-year mark after musculoskeletal procedures.

Pain is a necessary but undesirable consequence of surgery, and surgeons are responsible for understanding effective treatment options and how to deal with acute exacerbation of chronic pain. We use our best judgement to provide appropriate therapy, and a specific strategy with protocols is helpful. Managing patient expectations may be the most important aspect of their care. Surgeons are part of the solution in this significant problem; we must be proactive.

Here are 10 strategies our surgical group has implemented to reduce the use of opioids in our practice:

  1. Initiating a preoperative discussion about expectations and postoperative pain options.
  2. Identifying patients who already are on chronic pain meds and communicating with their pain management   physician.
  3. Ensuring preoperative administrative use of Gabapentin and NSAIDs with a defined protocol.
  4. Collaborating with our anesthesia colleagues regarding increased use of epidurals, local /regional blocks, and On-Q pain pumps.
  5. Working with hospital P&T committee for the approval of IV Tylenol and long-acting bupivacaine.
  6. Encouraging ERAS protocol for limited opioid use post op which also reduces post op ileus. Expanding ERAS for other procedures as well.
  7. Providing post op counseling for expected duration of opioid use.
  8. Setting procedure-specific limits on opioid pain meds; for example, hernias and laparoscopic cholecystectomies.
  9. Establishing call and weekend policies that limit prescription-seeking behavior and doctor shopping. PDMP monitoring is now required.
  10. Conducting practice risk management reviews and shared review of quarterly PDMP reports.

Posted in: Colorado Medicine | Initiatives | Prescription Drug Abuse


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