90 Percoces and how easy it is to prescribe opioids: vaccines


Doctors often prescribe more opioid badgesics than necessary after surgery for a variety of reasons.

Images of education / UIG through Getty Images

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Education images / UIG using Getty Images

Doctors often prescribe more opioid badgesics than necessary after surgery for a variety of reasons.

Educational images / UIG through Getty Images

I recently limped to the pharmacy to take painkillers after a minor outpatient knee surgery, only to discover that the pharmacist had not yet filled out the prescription. The order of my generic 90 Percocet doctor exceeded the number my insurer would approve, he said. I left shortly after with a bottle that contained a smaller number.

When I got home and opened the package to take a pill, I discovered that there were 42 inside.

Talking about using a shotgun to kill a mosquito. I was stiff and sore after the orthopaedist pulled out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of zero to 10, I had four, at most. It probably could have survived with a much less potent drug than an badgesic like Percocet, which contains a combination of opioid oxycodone and badgesic acetaminophen, the active ingredient found in over-the-counter Tylenol.

When I went for my follow-up appointment a week after the surgery, I asked my orthopaedist about those 90 pills.

"If you had a real surgery, like a knee replacement, you would not think there were so many," he said. He told me that the electronic prescription system sets the default value to 90. Therefore, when you enter a recipe for Percocet, that is the amount ordered by the system.

You can override such standard orders, but that's an additional step for a busy doctor and it takes time.

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While public health officials grapple with how to curb the growing opiate epidemic, which claims 91 lives every day, according to federal statistics, excessive prescribing of narcotics after even minor surgery are under new scrutiny.

While patients are given opioids to control postoperative pain, a large supply of pills may open the door to the abuse of opioids, either by the patients themselves or by others in the family or community that accesses them. the left overs.

Postsurgical prescriptions for 45, 60 or 90 pills are "incredibly common," says Dr. Chad Brummett, anesthesiologist and pain physician at the University of Mi chigan Medical School.

Last year, the Centers for Disease Control and Prevention issued a general guide that doctors who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no more than seven. days. [19659008] But doctors say that a more detailed guide is needed.

"There really are no clear guidelines, especially for surgery and dentistry," says Brummett. "It's often based on what their main resident taught them on the road, or an event in their career that forced them to prescribe a certain amount."

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Or as in my case, an automated program that makes prescribing more pills easier than prescribing less.

Brummett is co-director of a Michigan program that has published recommendations for the prescription of postoperative opioids for a growing list of procedures.

To determine the extent to which surgery can lead to the use of long-term opioids, Brummett and his colleagues examined the insurance claims of more than 36,000 adults who underwent surgery in 2013 or 2014 for those who received a prescription for opiates. None of the patients had opioid prescriptions during the previous year.

The study, published online in JAMA Surgery June [encontróquedetresaseismesesdespuésdelacirugíaaproximadamenteel6porcientodelospacientestodavíausaropioideshaberllenadoalmenosunanuevarecetaparaelmedicamentoLascifrasfueronsimilaresyaseaquehayantenidounacirugíamayoromenorEncomparaciónlatasadeusodeopiáceosparaungrupodecontrolquenotuvocirugíafuesolodel04porciento

Some insurers and state regulators have intervened to limit opioid prescriptions. Insurers routinely monitor doctors' prescription patterns and limit the number of pills or the dosage of opioid prescriptions.

At least two dozen states have pbaded laws or regulations in recent years to regulate the use of opioids.

In my state of New York, Governor Andrew Cuomo signed legislation last year that reduced the initial limit of prescription opioids for acute pain from 30 days to no more than seven days.

As my experience showed, however, a seven The limit of that day (those 42 pills in my case) may still result in patients receiving many more pills than they need. (For those who are in a similar situation with excess pills, there is a safe and adequate way to get rid of them.)

Still, some fear that all this focus on over-prescribing may scare doctors so that do not prescribe opiates, even when they are appropriate.

"That's my concern, that people are so afraid of things and take it to such an extreme that the patient's attention suffers," says Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women's Hospital in Boston. Michna is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.

But other doctors say that one of the reasons doctors call for many pills is convenience.

"When you land on the front lines, you listen, I like to write for 30 or 60 pills because that way they will not call in the middle of the night & # 39;" for a recharge, says the Dr. Martin Makary, professor of surgery and health policy at Johns Hopkins School of Medicine.

Makary heads a Hopkins medical and patient consortium that provides specific guidelines for the use of postoperative opioids. The program, part of a larger effort to identify areas of overtreatment in medical care, also identifies atypical prescribers across the country to encourage them to change their prescribing habits.

The Hopkins group does not have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a piece of broken cartilage in the knee called meniscus. The recommendation of postoperative opioids after surgery: 12 tablets.

Kaiser Health News is an editorially independent news service that is part of the non-partisan family foundation Henry J. Kaiser. Follow Michelle Andrews on Twitter @ mandrews110 .

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