COMMENTARY ON TECHNIQUE/CASE REPORT defined as diversion of unused opioid pills. necessary number of opioid medications only Surgeons as Part of the We as surgeons need to acknowledge that the along with clear patient instructions on how Solution days of prescribing a large number of opioid to dispose of extra pills. pills, ‘‘just in case’’ and to ‘‘avoid that phone Standardization: The degree of varia- call in the evening or weekend’’ asking for tion in the amount of opioid being prescribed Changing the Culture of pain medication refills, are simply gone. for similar patients and similar procedures is Opioid Prescribing Some patients might legitimately require clear. Procedure-specific guidelines and pro- more pain medications, but we cannot afford tocols recommending a limited and set num- prescribing extra amount of opioid pills to ber of pills to be prescribed are needed, and our patients anymore. several institutions are making progress in n this pointed research letter, Thiels et al Surgical Culture: Legislation like that that domain. Policy-makers need to know I report that the amount of postoperative passed in Massachusetts and other states and that surgeons were perhaps part of the prob- opioid prescribing in their institution has guidelines on opioid prescribing are all help- lem in the past, but they are now part of recently decreased, perhaps due to more ful. However, at the core of the solution (or the solution. recent awareness of the opioid epidemic our role as surgeons in the solution) is chang- among patients and providers. View this ing the prevalent culture of opioid prescrib- Haytham M. A. Kaafarani, MD, MPH, unprecedented opioid epidemic across the ing. In the report by Thiels et al, the mere FACS nation, 3 important concepts are key for awareness of the scope of the problem led to a Department of Surgery, Massachusetts our understanding, as surgeons, of this epi- statistically significant decrease in opioid General Hospital and Harvard Medical demic, our role in it, and how we can be part prescription in most of the surgical proce- School, Boston, MA. of the solution. dures in the authors’ institution. Changing firstname.lastname@example.org Opioid Diversion: The data reflect that the prevalent culture requires that surgeons surgeons are realizing more and more the role understand 3 main issues: 1) we need to set that opioid pills’ diversion plays into the the patients’ pain expectations as early as REFERENCES opioid epidemic. Recent data suggest that possible, whether in the clinic or emergency 1. American Society for Addiction Medicine. Opioid only 20% of substance abuse patients room—the goal is tolerable pain, not zero Addiction 2016 Facts and Figures. Available at: obtained their opioid pills through a prescrib- http://www.asam.org/docs/default-source/advo- pain, 2) alternatives to opioids not only exist cacy/opioid-addiction-disease-facts-figures.pdf. ing physician, while 65% obtained/took them but are efficacious— multimodal pain man- Accessed August 11, 2016. from a friend or relative. The even more agement is essential, and medications such as 2. Kaafarani HMA, Weil E, Wakeman S, et al. The staggering statistic is that 82% of these acetaminophen, ibuprofen and gabapentin opioid epidemic and new legislation in Massachu- friends/relatives were prescribed the pills are even more effective than opioids in cer- setts: time for a culture change in surgery? Ann through a single physician; this is what is Surg. 2017;265:731–733. tain situations, and 3) we should prescribe the The author reports no conflicts of interest. Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/17/26703-0e48 DOI: 10.1097/SLA.0000000000002631 e48 | www.annalsofsurgery.com Annals of Surgery Volume 267, Number 3, March 2018 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Annals of Surgery – Wolters Kluwer Health
Published: Mar 1, 2018
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