Surgeons as Part of the Solution

Surgeons as Part of the Solution 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 hkaafarani@mgh.harvard.edu 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Surgery Wolters Kluwer Health

Surgeons as Part of the Solution

Free
1 page

Loading next page...
1 Page
 
/lp/wolters_kluwer/surgeons-as-part-of-the-solution-O9Ji3P5yU2
Publisher
Wolters Kluwer
Copyright
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
0003-4932
eISSN
1528-1140
D.O.I.
10.1097/SLA.0000000000002631
Publisher site
See Article on Publisher Site

Abstract

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 hkaafarani@mgh.harvard.edu 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.

Journal

Annals of SurgeryWolters Kluwer Health

Published: Mar 1, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off