Doctors continue to prescribe far too many opioid painkillers to patients following surgery, a new study indicates.
In fact, one of every three patients prescribed an opioid, such as Oxycontin, didn’t take a single pill during their recuperation, said lead researcher Elizabeth Habermann. She is scientific director for surgical outcomes at the Mayo Clinic in Rochester, Minn.
“Their entire prescription amount went unused,” Habermann said. “That showed us there’s an opportunity to prescribe a certain select group of patients zero opioids, and they may be able to take care of their pain with acetaminophen [Tylenol] or NSAIDs alone.” NSAIDs are nonsteroidal anti-inflammatory drugs, such as Motrin or Advil.
Overall, nearly two-thirds of opioids prescribed after surgery went unused by patients, the study found. These drugs wound up lingering in patients’ homes, inviting abuse and the potential for addiction, Habermann said.
“Fewer than 10 percent of patients disposed of their leftover opioids. We know from the literature that many individuals who are taking heroin actually started their use of narcotics with leftover prescription opioids prescribed to others. So this is a huge risk to our community,” she explained.
Mayo undertook the study because there is a lot of variation in how many opioids are prescribed to patients, and some indication that the amounts being prescribed are too high, Habermann said.
The research team surveyed 2,550 adults who underwent 25 different elective procedures at three different medical centers.
A few weeks after their surgery, the patients were asked how many opioids they had been prescribed, how many they had used to deal with their pain, and whether they’d thrown away the leftovers.
About 28 percent of patients said they had been prescribed too many opioids, versus 8 percent who said they were prescribed too few, the findings showed.
Certain procedures proved painful enough that patients took a good amount of opioids, and even requested refills. These included total knee replacements, spinal fusions, rotator cuff surgery, lung removal and tonsillectomy, according to the researchers.
But there were many more procedures where people needed little to no opioids to deal with their pain. These included surgical removal of thyroid glands, carpal tunnel surgery, breast lumpectomy, mastectomy and hernia repair.
The findings were to be presented Thursday at the American Surgical Association annual meeting in Phoenix. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.
Linda Richter is director of policy research and analysis at the National Center on Addiction and Substance Abuse. The study “just adds to the evidence that, despite all the attention the opioid epidemic has been receiving, opioid overprescribing remains a serious problem in the United States,” she said.
“The fact that opioid overprescribing has fueled the prescription opioid crisis, which has recently morphed into an illicit opioid crisis, is no secret,” Richter continued. “The fact that it’s continuing to happen on this scale despite all we now know about the adverse consequences is frankly quite depressing.”
Habermann suggested that doctors need to adopt a patient-centric approach to prescribing opioids, using the best medical evidence to target these drugs to the procedures that appear to require heavier levels of pain management.
Mayo has used the study over the past six months to develop guidelines that will help surgeons prescribe opioids based on the procedure patients are undergoing and the likelihood that they will be in extreme pain during recovery, Habermann noted.
“We don’t want to withhold necessary opioids from our surgical patients, but these data have helped us better target how much to prescribe,” she pointed out.
“In orthopedic surgery, we’ve been able to decrease the amount prescribed by 50 percent, and there’s been no associated increase in refills,” she added. “That shows patients are getting as many as they need.”
In the meantime, patients who’ve been prescribed too many opioids should dispose of them, Habermann said.
“The [U.S. Food and Drug Administration] actually has a website where it suggests flushing leftover opioids down the toilet,” she said. “Ideally, we don’t want pharmaceuticals entering our water supply, but in the case of opioids that is suggested so we can have them unavailable to others.”
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