The opioid epidemic is an emergency in this country — according to the U.S. Department of Health and Human Services, in 2016 more than 100 people died every day from opioid-related drug overdoses. One of the most common vectors for addiction isn’t as widely-known: the operating room. Ninety percent of patients receive opioids for pain management after surgery, and studies have shown that 1 in 10 of them will go on to long-term opioid use. That means nearly 3 million new opioid users are emerging from the operating room every year — many of whom are overprescribed to begin with.
The medical community is taking notice, however, and adopting new, effective non-opioid pain management solutions.
The problem with overprescribing
Paul Sethi, M.D., an orthopedic surgeon specializing in sports medicine and president of the ONS Foundation for Clinical Research and Education, says doctors overprescribe opioids out of a desire to ensure the needs of their patients are covered, “But then we over-prescribe and contribute to the problem of diverted medications,” he notes. “I said, ‘I need to look at strategies where I can have fewer pills from prescriptions that I write get into circulation.’”
The subject is a personal one for A. Omar Abubaker, D.M.D., Ph.D., an oral and maxillofacial surgeon and professor and S. Elmer Bear chair at Virginia Commonwealth University. His own son, Adam, became addicted to opioids after a surgery and died of an overdose at the age of 21. Dr. Abubaker agrees that over-prescribing is part of the problem.
“Almost every study done shows the average oral surgery patient consumes only between 6 to 8 tablets of opioids,” says Dr. Abubaker. “If I anticipate a patient will have pain because of a difficult procedure, or if they’re lower-risk of addiction, then I give a prescription for an opioid. But I have not written a prescription for more than six to eight tablets over the last six months, and I have not had people coming back.”
Moving away from opioids
Richard Chudacoff, M.D., OB/GYN, of Moore County Obstetrics and Gynecology in Dumas, Texas, has avoided opioid use when appropriate, using a local anesthetic made by Pacira Pharmaceuticals called EXPAREL (bupivacaine liposome injectable suspension) when he performs cesarean sections. When injected during a procedure, the product releases a numbing medication directly at the surgical site to control pain over a prolonged period of time to reduce, or in some cases, eliminate, the need for opioids.
“Studies show us that patients who get up and moving and out of the hospital quicker do better than patients who stay in the hospital. This is particularly important for new mothers, and opioids often get in the way of this goal.”
Dr. Sethi also incorporates EXPAREL as part of a low-opioid pain management strategy. “We’re using non-opioid oral medications, anti-inflammatory medications and then EXPAREL as an adjunct solution,” he says. “My experience is that the pain is just as effectively managed with opioid alternatives.”
Patients who know what their non-opioid options are after surgery — or that there even are such options — are in a much better position to drive the conversation with their health care providers. Based on his own experience, Dr. Chudacoff agrees that educated patients are key to advocating for better pain management in the future. “I had one doctor call me up who said, ‛I need to know how to implement a non-opioid pain management program because the patient asked for it.’”
Patients have options and the right to make informed decisions about their care and pain management. If you or a loved one is considering surgery, ask about a pain management plan and what can be done to minimize exposure to opioids.
Learn more about reducing opioids after surgery at https://www.exparel.com/patient/index
Important Safety Information
EXPAREL should not be used in obstetrical paracervical block anesthesia. In studies with EXPAREL, the most common side effects were nausea, constipation, and vomiting. EXPAREL is not recommended for use in patients younger than 18 years of age or in pregnant women. Tell your healthcare professional if you have liver disease as this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from your body. EXPAREL should not be injected into the spine, joints, or veins. Other local anesthetics should not be injected immediately after injecting EXPAREL; this may lead to an immediate release of the active ingredient in EXPAREL. The active ingredient in EXPAREL can affect your nervous and cardiovascular system, may cause an allergic reaction, and/or if injected into your joints may cause damage to the joints.
Jeffrey Somers, [email protected]