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A Nation in Crisis
Surgeons helped cause the opioid addiction problem. Now they can be part of the solution.
Daniel Cook
Publish Date: January 22, 2020   |  Tags:   Patient Safety
PILING ON Healthcare professionals who failed to understand the seriousness of the opioid addiction epidemic put countless patients in peril.

To prevent the next patient from getting hooked on opioids, let’s first consider what helped cause the national epidemic to spiral out of control. It wasn’t surgeons passing out opioids like aspirin, pill mill docs looking to profit off drug-seeking patients or addicts working the system for their next fix. The proliferation of opioids in communities across the nation can be linked to well-meaning surgeons who prescribed excessive amounts of painkillers to keep their patients comfortable after surgery because, well, that’s how they’d always done it.

“Surgeons of course know about the opioid crisis, but they might not realize that their overprescribing is contributing to the problem,” says Andrew Kolodny, MD, co-director of the Opioid Policy Research Collaborative at Brandeis University in Waltham, Mass. “The surgical community is much more aware of the epidemic, but that awareness hasn’t yet translated into appropriate prescribing practices.”

Surgeons are beginning to rely less on opioids to manage post-op pain, but it’s going to take time for physicians to alter their prescribing habits, says Michael Manning, MD, an assistant professor of anesthesiology at Duke University School of Medicine in Durham, N.C.

The overall impact of the crisis should provide the evidence surgeons need to alter how they use opioids, says Dr. Manning. Consider, he says, the following troubling statistics:

  • 50 million surgeries are performed each year, and 90% of patients are prescribed opioids to control post-op pain.
  • As many as 6.5% of patients (about 2.6 million) who have major surgery become chronic users.
  • About 440,000 of those 2.6 million chronic users will become addicted.
  • 1 billion opioid pills each year go unused by recovering patients.
  • 32% of opioid addicts say their first exposure came from someone else’s leftover supply.
  • $13 billion in annual healthcare costs associated with the treatment of opioid addiction can be linked to post-op pain management.
  • 20% of patients who take opioids daily for 10 days and nearly 40% of patients who take opioids daily for 30 days will still be on opioids a year later, says the CDC.
  • 85% of pills that enter communities come from surgeons or dentists.

As recently as 5 years ago, many surgeons were largely unaware of the dangers of overprescribing to opioid-naïve patients and that they were helping to fuel a staggering epidemic, according to Dr. Kolodny. “That speaks to the need for more caution before writing first-time prescriptions,” he says. “Improving prescribing practices after surgery is critical to addressing the current crisis.”

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