Patients Comfortable with Fewer Pain Pills

A dedicated group of surgeons at the University of Michigan is spearheading the effort to curb the nation’s opioid epidemic by changing the way they prescribe opioids in their own hospital.

This week in JAMA Surgery, a research team at Michigan Medicine released a new study, Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines, where they highlight the results of prescribing fewer opioids for post-operative pain. This research comes amid continuing coverage of the opioid epidemic and overwhelming evidence that many opioid prescriptions written by surgeons remain unused.

Here are some of the facts about the opioid epidemic in the United States:

Deaths from drug overdose in this country exceeded 60,000 last year
Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to overdose incidents and deaths
The majority of drug overdose deaths (more than six out of ten) involve an opioid
Of those opioid-related fatalities, nearly half involved a prescription opioid
Among adults who misuse opioids, over 40% obtained prescription opioids for free from friends or relatives

Many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period. Similarly, leftover opioids are a major contributor to the opioid epidemic. Heeding this data, Michigan’s researchers devised a study to evaluate prescribing guidelines which reduce the excess of unneeded medication. They found they could cut unnecessary opioid prescriptions without negatively impacting post-surgical pain control. That seemingly small intervention could lead to significant changes in how opioids are prescribed in this country.

The researchers identified 170 patients who underwent gallbladder surgery and surveyed them within a year of the operation. They tracked how many pills they used, what level of pain they experienced and whether they had used other painkillers during the recovery process. Accordingly, these investigators found that patients who underwent gallbladder removal surgery received a prescription for significantly more opioids than they actually ended up using. They then used their findings to create new prescribing guidelines that cut back opioid prescriptions following gallbladder surgeries.

They found that despite getting less medication, patients did not report higher levels of pain.

The researchers at Michigan Medicine instituted new opioid prescribing guidelines hospital-wide. Within five months of changing the guidelines, the volume opioids prescribed by Michigan’s University Hospital was reduced by roughly 7,000 pills.

“We’re trying to prevent addiction and misuse by making sure patients themselves who are receiving opioids know how to use them more safely — that they are getting a more consistent amount and one that will reduce the risk of them getting addicted,” said Jay Lee, one of the paper’s authors.

Taking from the CDC’s Guideline for Prescribing Opioids for Chronic Pain, the researchers also encouraged their physicians to have open and honest discussions with patients as they start or continue opioid therapy. Important considerations include:

Encouraging patients to use lower-strength, non-addictive painkillers
Advise patients about serious adverse effects of opioids, including potentially fatal respiratory depression and the risks of addiction
Reminding them about the expected benefits of opioids, explaining that complete relief of pain is unlikely

Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers. While adjusting prescribing guidelines will not solve the opioid problem in the United States, this is a small step to preventing opioid misuse. It is critical that we continue to support actions that not only seek to prevent opioid dependence but address those already addicted to these powerful medications. Treatment is vital to affecting the epidemic as a whole.