Experts say the opioid epidemic in the United States can in part be attributed to overprescribing.
But now, researchers at the University of Michigan have concluded that surgeons can dramatically reduce the amount of opioid medications prescribed to patients following surgery, without impacting their level of pain control.
“We felt inspired to do this study because of the epidemic of opioid misuse and abuse in America. Over 90 Americans die each day from opioid overdoses. Surgeons play a key role here. We prescribe 10 percent of all opioid prescriptions in this country,” Dr. Jay Lee, general surgery resident at the University of Michigan and one of the authors of the study, told Healthline.
“Before this study, we were just guessing about how much opioids our patients needed to adequately relieve pain after surgery,” Lee added. “Because of this, many patients were prescribed too much opioid medication. This led to increased rates of addiction and a large amount of leftover opioid pills in the community. These leftover medications often ended up in the hands of people who misused them.”
What the study revealed
Lee and his colleagues set out to establish and test a guideline for surgery-related opioid prescriptions.
They gathered data from 170 people who had undergone gallbladder surgery and determined how many pills they had been prescribed, how many they took, and how well their pain was controlled.
They found that although the average participant received a prescription of around 250 milligrams of opioids (or about 50 pills), 100 of those surveyed said they only took about six pills.
The rest remained in their medicine cabinet.
Dr. Chad Brummett, director of the Division of Pain Research at the University of Michigan and a co-author of the study, said this tendency to stockpile pills is a disaster waiting to happen.
“Most people with unused tablets put them away in an unsecured medicine cabinet or drawer. These can be taken by their kids, family, neighbors, and visitors, and the effects can be devastating. People should not hold onto these medications ‘just in case.’ They should find a safe disposal site in their community,” Brummett told Healthline.
Prescribing lower doses
When the University of Michigan researchers found that patients seemed to be prescribed more pills than were needed, they developed a trial guideline for prescriptions with lower amounts of opioids.
The patients who received a smaller prescription under the new guidelines reported the same level of pain control as those originally studied.
Lee is hopeful the findings of this study will lead to more appropriate prescribing of opioids across the United States.
“Although some doctors have been doing a great job with prescribing the right amount of opioids after surgery, most of us have been prescribing far too much,” he said. “This happened because even doctors weren’t aware of how addictive these medications can be. In the past five years, it’s become very clear that these medications can be very addictive.”
Opioid epidemic rising
Between 1997 and 2011, there was a 900 percent increase in the number of people seeking treatment for opioid addiction in the United States.
Both the number of sales of prescription opioids and the number of overdose deaths involving the drugs has quadrupled since 1999.
Of those who began abusing opioids since 2000, 75 percent reported their first opioid was a prescription medication.
Many first encounter opioids through their doctor or dentist following a surgery or procedure, but experts say these people often fail to understand how addictive opioids are.
“The average patient does not understand that these are highly addictive drugs, and unfortunately the average prescriber doesn’t recognize it as well,” Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University and executive director of Physicians for Responsible Opioid Prescribing, told Healthline.
Less than a week on opioids, he says, can leave patients vulnerable to developing a dependence on the drug.
“If you take an opioid every day for 5 days, physiological dependence on the drug is already starting to set in,” Kolodny said.
“If you take an opioid every day for 10 days, one in five patients will wind up on an opioid for more than a year… and if you take an opioid every day for 30 days, more than 40 percent of patients are stuck on opioids for more than a year. The physiological dependence will happen to everyone, and for some it will lead to long-term use.”
Reducing opioids after surgery
Dr. Anna Lembke is the medical director of addiction medicine at the Stanford University School of Medicine and author of the book, Drug Dealer, MD.
She says curbing access to opioids by reducing prescriptions after surgery is crucial to overcoming the country’s opioid crisis.
“Surgery has become a gateway to opioid addiction in the United States. Americans today are getting more surgeries than ever before in our history, and even minor surgery carries a risk of creating a chronic-pain syndrome, by simple virtue of cutting across nerves. One in 10 opioid naive patients who undergoes even a minor surgery will go on to be a persistent prescription opioid user at three months,” she told Healthline.
All of the experts who spoke with Healthline acknowledge that opioids still play an important role in medicine, despite their addictive risks. They are an important method of treatment of severe acute pain and in easing suffering at the end of life.
“They will still always play a role, and there will be times we need to prescribe them,” Kolodny said.
“When we do need to prescribe them, the key is to keep the dose as low as possible and to expose the patient for as brief a time as possible. The longer you expose them, the greater the risk.”