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.