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It may not be rocket science, but a group of surgeons at the University of Michigan has devised an approach to help curb the nation's opiate epidemic, starting at its own hospital.
Opioid addiction has been considered a "public health" emergency "by the White House, estimated to have claimed 64,000 lives alone in 2016. And research shows that postsurgical patients are at increased risk of addiction due to the medications they receive to help control pain during recovery.
To reduce the risk, there is a simple remedy: surgeons should administer fewer pills to patients after surgery, the time when many people present for First time to what may be highly addictive analgesics.They should also talk to patients about the proper use of opioids and the associated risks.
That seemingly small intervention could lead to significant changes in the way opioids are prescribed. and advance the current epidemic, the researchers said, their findings were published on Wednesday in the journal JAMA Surgery.
"The way we have been prescribing opioids up to this point is that we have basically been guessing how much the patients would need," said Jay Lee, a researcher and resident in general surgery at the University of Michigan, and one of the authors of the article. "We are trying to prevent addiction and misuse by making sure that patients who are receiving opioids know how to use them more safely, obtain a more consistent amount and reduce the risk of them becoming addicted."  Researchers identified 170 patients who underwent gallbladder surgery and surveyed them within one year of the operation on how many pills they actually used, what pain they experienced after surgery, and whether they had used other pain killers, such as ibuprofen. .
used the findings to create new hospital guidelines that reduce the standard prescription of opioids for gallbladder surgeries.
Next, they analyzed how patients went under the new approach, tracing 200 surgery patients who received substantially fewer pills: an average of 75 milligrams of opioid analgesics, specifically oxycodone or hydrocodone / acetaminophen. Previously, the average dose was 250 milligrams.
Despite obtaining less medication, patients did not report higher levels of pain, and were not more likely than previously studied patients to request prescription refills. They were also likely to use fewer pills.
The conclusion: after surgery, patients are prescribed more opioids than necessary and doctors can reduce the amount without experiencing negative side effects.
Within five months of the adoption of the new effect guidelines at the University Hospital of Michigan, surgeons reduced the volume of prescription opioids by approximately 7,000 pills. It has been a year since the change took effect, and researchers estimate that they have restricted prescriptions by approximately 15,000 pills, said Ryan Howard, general surgery resident and lead author of the article.
The reduction has real implications.
"This really shows in a very methodological way that we are over-prescribing dramatically," said Michael Botticelli, who spearheaded the drug control policy under Obama's White House, including the administration's response to the opiate crisis.
"Not only do we have to reduce supply to avoid future addictions, but we really have to minimize opportunities for diversion and misuse," he said.
More hospitals are starting to turn in this direction, said Botticelli. He now runs the Grayken Addiction Center at Boston Medical Center, which is also trying to systematically reduce opiate prescriptions after surgeries.
Meanwhile, 24 states have passed laws to limit how many pills a doctor prescribes at a time, according to the National Conference of State Legislatures.
The researchers also created "common sense" talking points for doctors and nurses to use with patients. They include:
- Encourage patients to use low-intensity, non-addictive analgesics first;
- Warn about the risks of addiction; and
- Recalling that even a sufficient prescription of opiates would leave them feeling some pain.
Discussion points also offer advice for patients to safely store and dispose of additional pills.
"Much of this problem can be addressed with solutions that are not complicated," said Julie Gaither, an instructor at Yale School of Medicine. Gaither has investigated the consequences of the opioid epidemic, although he did not participate in this study.
Kaiser Health News is a non-profit news service covering health problems. It is an independent editorial program of Kaiser Family Foundation that is not affiliated with Kaiser Permanente.