President Trump’s recent call to reduce opioid prescriptions by one-third over the next three years may seem like a daunting task, even unrealistic. But it’s possible to do right now — without a lot of fanfare, new regulatory rules, or torturous legislation.
The solution lies with surgeons like us. Until now, we have not really had any data to guide us when deciding how much of an opioid painkiller to prescribe when patients are discharged from the hospital after major surgery. And many with substance use disorder admit that they initially became dependent on opioids through prescriptions following medical procedures.
Research we conducted and published in the Journal of the American College of Surgeons shows how surgeons can determine an appropriate prescription. We found that many patients use less than one-third of the opioids prescribed to them, allowing unused medications to sit in a bathroom cabinet or be diverted or stolen for illicit use.
Deaths from opioid overdoses have more than quadrupled in the past 15 years, to at least 42,000 per year, and are now the leading cause of injury-related mortality in the United States. An important contributor to this problem is the quadrupling of the number of opioids prescribed during this same time.
Our study evaluated 333 hospital inpatients discharged home after six different types of general surgery operations: bariatric procedures; operations on the stomach, liver, pancreas, and colon; and ventral hernia repair.
The most important finding from the 90 percent of survey respondents was that the number of opioid pills taken the day prior to discharge was the best predictor of the number used at home by patients. This allowed us to formulate a simple guideline for discharge opioid prescribing that would satisfy at least 85 percent of patients’ home opioid needs. If no opioids were used the day prior to discharge, none should be prescribed; if one to three opioid pills were used the day prior to discharge, 15 pills should be prescribed for five days of pain relief; and if more than four pills were used the day prior to discharge, 30 pills should be prescribed.
This guideline would apply to a variety of different surgical procedures. We found that the type of surgery patients had did not affect the number of pills they used at home. If we used this guideline instead of our standard opioid prescribing, the number of opioid pills prescribed would decrease by 40 percent.
We know that surgeons will change their practice when shown good data. In previous studies of opioid prescribing after outpatient general surgical operations, we found out how many opioid pills patients needed after surgery and used that to formulate prescription guidelines. By simply educating the surgeons in our group at Dartmouth-Hitchcock Medical Center, we were able to cut opioid prescribing by general surgeons by more than half and still take care of patients’ pain.
There is no need to politicize or endlessly legislate this simple process that could have a meaningful impact on the opioid epidemic. We in the medical community can take action today.
Richard J. Barth is chief of general surgery and Maureen V. Hill is chief resident of general surgery at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
I hope, if nothing else, this ‘witch hunt’ will help to educate a lot of ignoramuses about what it’s like to live in excruciating pain 24/7. There are none so blind as those who will not see. Please help us, somebody, somewhere to get our medicine. We need it oh, so bad. Have you ever seen so many people begging for help? I did like Trump but if he’s taking any part in keeping our medicines from us, then he does not deserve my vote or any other humans (or dogs) vote! I am in extreme pain and will be to the day I die, I have had surgeries, procedures, you name it (and friends and relatives not associating because I take medicine) and I am no addict, but I cannot live without medicine. It’s the only way I can function in this world.
I have multiple chronic pain issues and I have always taken my pain pills responsibly . For all the people who do the same, we have to go to the E R every day to manage living thru a day. The President has not concidered the people that really need thier prescriptions and have not figured out a solution. Taking away my meds and ALL the people who suffer debilitating diseases is unacceptable. We r not abusing we are in pain Management with close monitoring and should be able continue receiving our scrips . President Trump What are we suppose to do ? The Government should NOT stop 🛑 are medicine we desperately need to make it thru a day . Sincerely Elizabeth Marquez
My wife was in a hospital in Dothan al.she just had a baby ask for a Tylenol and the nurse tried to convince her to get something stronger.she refused and nurse acted surprised.I feel that is the problem when someone has a little pain they want to start with strongest thing possible.the hospitals are to blame when she left she told them she was in no pain and they still gave her a prescription for dilad but had a generic name so she bought it along with other meds on script not knowing that is what it was I am glad she hasn’t took any of it.But I was told I couldn’t smoke a cigarette in parking lot.
Smoking has no good qualities to speak of, but there are numerous diseases acquired from its use and if it doesn’t kill you, the life-limiting disabilities will put you at death’s door until you finally succumb from one of them. But, YOU sir, are allowed to purchase cigarettes and smoke them and die if you choose. No one says you can’t buy or smoke them, the law just says where you can’t smoke. Unlike chronic pain patients, Trump 😏 made the decision about opiate use for us. No one said “you can take your opiate prescription, but not in public” which is what tobacco smokers were told. No one asked the Pain Specialists who have medical degrees and many years of treating chronic pain how they felt about the so called “opiate crisis”. Chronic pain patients did not cause nor were we involved in creating this witch hunt. We are law abiding citizens who for whatever reason, now get to spend the rest of our life crippled by unrelenting pain. We have gone that extra step to be referred to a Pain Specialist, undergoing multiple scans, blood work, surgery, physical therapy, injections into every area of our body many times over, and some even sent for psychological counseling just to make sure they weren’t depressed before even getting accepted into a Pain Clinic. Once we are accepted, we sign contracts stating that we will abide by the LONG LIST OF RULES in order to remain a patient. We then undergo unplanned urine and/or blood toxicology testing when we report for our monthly appointment/prescription. It doesn’t matter if you just used the bathroom down the hall — you have two choices: either pee in a cup within 3 feet of an attendant without taking your coat or purse with you, among other rules, and if you pass the test, you will see the doctor and get your medications. OR #2. Drink some water to make yourself pee and if you refuse to present a sample, you will not be seen nor get any prescriptions and you will 99.9% be dropped by that doctor. You have a choice, we do not! What caused the crisis is the illegal medications bought off the street, shared at parties when prescriptions are stolen, people who take them in place of other drugs to ward off withdrawal, and the people who were discharged from pain clinics when they were revealed early on as “addicted” and wanting them to sell them which normally is found out within the first few visits to a pain doctor. Pain patients guard their prescriptions with their life. Most of us lock our prescriptions in almost a vault. We know that they will not be replaced under any conditions. We take our prescriptions as prescribed after many attempts to find the medication(s) that let us live a normal life as much as possible due to our underlying cause of pain. If the very people who are literally causing our pain levels to elevate to the point of some people committing suicide rather than live with their degree of pain, had a son or daughter who developed the degree of pain that we are experiencing, I am sure you would see him begging someone to help them. I am sure that the very “soapbox zealots”, who preach the horror stories of opiate sbuse and condemn its use, even going so far as to demand the medical licenses of highly educated Pain physicians, would surely change their point of view if they found themselves mangled in Shock Trauma and needed pain control. What goes around, comes around! I hope that one day, the very people who are making us live our life in hell due to the new opiate laws, get to experience the very same kind of pain as we have and have nowhere or no one to turn to. Wait until the prostate gland starts acting up in some of the men or maybe when men reach that age when they start passing kidney or bladder stones. Wait until hips start crumbling from age or when knees start with crippling arthritis. The very people who caused so many pain physicians and their patients lives to be turned upside down, will hopefully one day find out first hand what it is like when they get refused pain medication. But, being told not to smoke and being told you can’t have pain medication should not be viewed in the same sentence. The nurse was a kindhearted soul who probably thought your wife was scared to ask for pain medication for fear of being arrested or burned at the stake in this grossly exaggerated witch hunt. I applaud that nurse! You have a choice. Our choice was taken away from us along with the very people who should have the authority to make that decision, our doctors.