Turning Personal Tragedy Into Positive Change

Why does the opioid epidemic hit home for you?
Ilan Kirsh, my best friend from childhood, died on the stoop of my apartment in New York City because of an opioid overdose. We were attending medical school at the time with plans to enter a profession we both loved. It was a devastating loss. Ilan was a kind, smart and giving person. I think about him constantly and named my son after him to honor his memory.

What impact has the crisis had on the way you care for patients?
Several years ago, when opioid-related deaths were spiking in western Pennsylvania where I practice, a study was published about general surgeons giving patients too many opioids after major abdominal surgery (osmag.net/Rf8GBk). It struck a chord and I thought, Are we doing the same thing in our urology practice? We replicated the study and came up with similar, if not worse, results. It was a disconcerting finding — I was overprescribing opioids, even after losing my friend to an overdose.

What improvements did you make to your pain management protocols?
We wanted to show that it was not only possible to manage post-op pain without opioids, but that it was also safe and beneficial for patients to do so. During our study, we were shocked to find that patients who didn’t receive opioids ambulated easier, reported less pain and anxiety, and returned to work sooner. It’s been 2 years since I’ve given any opioids to patients who’ve undergone minimally invasive surgery.

Do you think some surgeons overprescribe opioids because it’s an easier way to control post-op pain?
Yes, but that’s not a perception based on reality. Changing a surgeon’s prescribing habits is challenging, but it can be done. I’ve convinced 9 of my colleagues to stop using opioids with monthly emails to let them know how many opioids they prescribed and how their rates compared with other surgeons. I also texted surgeons on the high end of the prescribing list to ask why they weren’t cutting back on opioid usage. The persistent communication paid off.

Should opioids still be part of effective pain management protocols?
That needs to be determined on a case-by-case basis. Do I still give them to patients? Sure. But I’ve found a vast majority do much better with alternative therapies. An increasing number of patients are aware of the risks associated with opioids, and don’t want to take them. That’s also been helping to decrease the number of scripts surgeons write. OSM