New studies support claims that surgeons prescribe too many opioids

New studies support claims that surgeons prescribe too many opioids

Has your surgeon prescribed more opioids than you really needed after a stay in hospital for an operation?

If so, you’ve got a lot of company.

A review of studies of post-surgical opioid prescribing by MedPage Today suggests that too many surgeons are much too liberal with their opioid prescribing.

MedPage editors say research indicates that opioid prescribing, especially after surgery, “is a reason the nation appears to be awash in the drugs and their abuse.” Doctor holding out varies pill packs

Earlier this year, we reported on a study at Baltimore’s famous Johns Hopkins Hospital that revealed how most orthopedic surgery patients leave the hospital with prescriptions for far more opioid pain pills than they need.

“Among 93 patients interviewed during the succeeding 4 weeks after discharge,” said an article in MedPage Today, “85 percent of those who had stopped taking the drugs still had them in the cabinet. And many of the patients had large numbers of tablets remaining: 28 percent had 20 or more pills still in their possession.”

Follow-up studies

In August, another MedPage Today article reported that Johns Hopkins followed up on their May study with an analysis of six other studies done at other locations. These confirmed the Johns Hopkins findings.

From 67 percent to 92 percent of patients reported not using prescribed opioids after surgery, and from 42 percent to 71 percent of the opioid pills prescribed for patients when discharged were never used.

“Physicians write a lot of prescriptions for patients to fill for home use after they have inpatient or outpatient surgery,” said Mark C. Bicket, MD, of the Johns Hopkins division of pain medicine. “But our review suggests that there's a lot we don't know about how much pain medication people really need or use after common operations."

Bicket told MedPage Today he was surprised at the high rates of unused opioids. “At least two out of every three patients reported leftover pills, a finding that was consistently high even among different types of surgery,” he said.

Even more evidence

MedPage reports that a 2013 study presented at the North American Spine Society reported that about one-third of patients undergoing back surgery were still taking opioids a year later. Half of those who had been on opioids prior to surgery were still using, as were 18 percent of those with no prior opioid history.

And a 2016 study in JAMA Internal Medicine found that surgical patients with no history of opioid use were at increased risk of long-term opioid use, i.e. more than a 120-day supply or 10 consecutive prescriptions, compared with nonsurgical patients with no opioid history.

Why does it matter?

Going home with way more opioids than you need is an open invitation to continue taking them for their euphoric side effects, which leads to dependence, addiction and the risk of overdose. And according to numerous studies, opioids left in the medicine cabinet are prone to theft by family members or visitors with a substance use disorder, or who know someone else who does.

And in a time when everyone is screaming about the high cost of drugs and health care, countless millions of unused, wasted opioid pills are adding millions of dollars to our health care costs.

The obvious solution would be to move away from opioids to alternative pain meds such as NSAIDS or gabapentin. In spite of a few studies that showed some efficacy, especially for gabapentin, the consensus among most surgeons remains that only opioids get the job done.

Recent stories have appeared about new research into novel painkillers, such as non-addictive opioids. But until then we need to tighten up on the prescribing and pay more attention to how pain patients are getting along.

How to dispose of unwanted opioids

Go to this FDA webpage to read everything you need to know about how to dispose of those leftover opioids and other medications in your medicine cabinet.

Meanwhile, don’t hesitate to call Novus if you or someone you care for has any kind of substance use problem. We’re the experts, and will help you find the solution that works for you

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