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Stop opioid addiction in a key source: the hospital



It may not be space science, but a group of surgeons from Michigan Medicine at the University of Michigan devised a strategy to curb the nation's opiate epidemic, starting with theirs. hospital.

Their findings appeared online Wednesday in the journal JAMA Surgery.

Addiction to opiates has been considered a "national emergency". It is estimated that 64,000 lives were claimed alone in 201

6. And the research shows that postsurgical patients are at increased risk of addiction due to the medication they receive to help control pain during recovery.

It's a pretty simple idea: surgeons should administer fewer pills to patients after surgery, when many people are first introduced to what can 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 progress in the current epidemic, the researchers said.

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. 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. "[19659005] Researchers They identified 170 patients who underwent gallbladder surgery and surveyed them within a year of the operation, asking them how many pills they actually used, what pain they experienced after surgery, and whether they had used other analgesics, such as ibuprofen.

used those findings to create new hospital guidelines that reduce the standard prescription of opiates for surgery s. of gallbladder.

They then analyzed how patients fared under the new guidelines, tracked 200 new surgery patients who received substantially fewer pills, an average of 75 milligrams, compared to 250 mg previously. Despite receiving fewer medications, 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 end: after surgery, patients are prescribed more opioids than necessary and doctors can reduce the amount without experiencing negative side effects.

Within five months of adopting the new effect guidelines at Michigan Medicine, surgeons reduced the volume of prescription opiates by approximately 7,000 pills. It has been a year since the change took effect, and researchers estimate that they have restricted prescriptions by about 15,000 pills, said Ryan Howard, general surgery resident and lead author of the article.

That has real implications. Studies have found that overprescribing opiates helps boost the epidemic. It can put patients at risk of addiction. And it endangers friends and family, who can easily acquire unused excess pills, for example, in an unsafe drug cabinet. Reducing recipes completely makes it less likely.

"This really shows in a very methodological way that we are prescribing too dramatically," said Michael Botticelli, who spearheaded the drug control policy under Obama's White House, including the administration's response to the opioid 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, Botticelli said. He now runs the Grayken Addiction Center at Boston Medical Center, which is also trying to systematically reduce opioid prescriptions after patients undergo surgery.

Meanwhile, 24 states have passed laws to limit how many pills a doctor can prescribe at a time, according to the National Conference of State Legislatures.

"Those limits are just a kind of generic limits in general," said Chad Brummett, a professor of anesthesiology at the University of Michigan and another co-author of the article. His concept, he added, "is one step beyond what some of these legislators are trying to do, and it's one that I think surgeons are more likely to adopt."

The researchers also created a set of talking points for doctors and nurses to use with patients based on "common sense" measures, Lee said. These include:

Discussion points also offer tips for patients to safely store and dispose of additional pills.

"Much of this problem can be addressed with solutions that are not complicated … like telling patients what to do with the medication when they finish using it," 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.

The Michigan team is pushing its new online prescription guidelines, hoping to encourage other hospitals to adopt similar practices. It has also begun to implement the change in other hospitals in the state.

Still, this only affects a small part of the problem, said Jonathan Chen, an assistant professor of medicine at Stanford University who also investigated opioid abuse and addiction. Most of the opioid prescriptions were written by family doctors and general internists, he said.

"This will not solve all the problems, but nothing does," said Chen, who was not involved in this study. "It's a concrete area and a natural place to start."


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