Opioid Alternatives & Patient Communication Help Combat Epidemic

America's struggle with the growing opioid epidemic has swept national headlines, with some reports estimating that 91 people die every day in the United States from the overuse of opioids.

America’s struggle with the growing opioid epidemic has swept national headlines, with some reports estimating that 91 people die every day in the United States from overuse of opioids. Even more astounding, is the fact that the U.S. makes up only 4.6 percent of the world’s population, but consumes 80 percent of its opioids. And the Surgeon General’s recent report highlighted that opioid analgesic pain relievers are now the most prescribed class of medications in the U.S., with more than 289 million prescriptions written each year.

As a practicing orthopedic surgeon, these numbers are astonishing and concerning. As medical professionals, it is our job to take care of our patients and give them the best care and advice as possible. Prescribing opioids after surgery for many weeks or months has been the primary practice over the last several years, but recently there has been an outcry for change.

A recent national survey found that 1 in 10 patients who receive an opioid after surgery will go on to long-term use. With 70 million surgical patients in the U.S. receiving an opioid annually, these findings suggest that as many as 7 million patients could develop an opioid addiction or dependency this year after surgery. This research also indicates that surgery has become an inadvertent gateway to the opioid epidemic and can put patients at risk for addiction and dependence.

To reduce this risk while effectively managing a patient’s post-surgical pain, it’s critical that patient providers communicate effectively with patients about their expectations of pain control and pain management options, including non-opioid options. By doing so, we will empower our patients and potentially mitigate the societal burden of opioid use. The war against prescription drug abuse must be waged on many fronts, and developing opioid minimization strategies within the hospital setting is a realistic first step.

In my own practice, I talk to my patients and their caregivers about a new approach I’ve implemented that helps to manage post-surgical pain while minimizing or, in some cases, completely eliminating the need for opioids after surgery. In addition to contemporary, minimally invasive, and soft tissue friendly techniques, this approach includes a long-acting non-opioid pain reliever called EXPAREL® (bupivacaine liposome injectable suspension) that is injected into the surgical site during a patient’s operation. By using this option, many of my patients are happy to hear that their pain will be managed with little or no use of opioids after surgery, and that they can be rapidly mobilized and return home faster. In fact, I have conducted many total knee and total hip replacement surgeries as outpatient cases due to contemporary techniques and multimodal pain management using EXPAREL.

Despite the availability of non-opioid options, many surgeons are still using and prescribing opioids at an alarming rate. The same survey mentioned previously also revealed that 91 percent of surgeons feel pressure to prescribe more opioids than patients actually need. In fact, providers wrote nearly a quarter of a billion opioid prescriptions in 2013 – which is enough for every American adult to have their own bottle of pills. This issue enables opioids to be easily shared, as over 65 percent of people misusing painkillers report getting them from family and friends. While prescribing guidelines are an important step in addressing this issue, the best way for doctors to take immediate action is to implement strategies and protocols that minimize preventable opioid exposure for patients.

The fight against prescription drug abuse will take many leaders, including national and local legislatures, media and the health care industry, but for many patients it starts in their doctor’s office. Times are changing, and the era in which opioids represent the keystone of pain management is over. Opioid alternatives are becoming more popular as the nation struggles to find solutions to the opioid epidemic. Even so, we have a long way to go. It’s imperative that health care professionals actively educate patients on the pain management options available to them, including non-opioid options. By doing so we empower them to have control over their own pain management plan, while potentially saving them from unnecessary opioid exposure.

Ritesh Shah, MD, FAAOS

Ritesh Shah, MD, FAAOSFellowship Trained Orthopedic Surgeon

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