Jack M. Bert
by Jack M. Bert, MD
The opioid crisis is a growing problem, and statistics show the opioid prescribing practices of orthopedic surgeons may contribute to this serious situation.
The National Institute on Drug Abuse reported there were 17,029 overdose deaths that involved prescription opioids in 2017. A 2015 study in the Journal of the American Academy of Orthopaedic Surgeons by Bert J. Morris, MD, and colleagues found orthopedic surgeons, as medical professionals, are the third highest prescribers of opioids.
Several studies presented at the 2019 American Academy of Orthopaedic Surgeons Annual Meeting underscore the impact of opioids on orthopedic patients.
Presentations at AAOS Annual M eeting
Anthony J. Porter, MD, and colleagues found patients undergoing knee arthroscopy for reasons other than ACL treatment consumed four pills, median, among 30 pills prescribed. In comparison, patients who underwent arthroscopic ACL surgery consumed 18 pills on average among 60 pills prescribed.
Connor A. King, MD, and colleagues, concluded in their study of patients’ opioid use and satisfaction after orthopedic surgery that increased use of opioids was not strongly associated with patient satisfaction.
De-An Zhang, MD, and colleagues concluded that 89% of opioids went unused in their study of outpatient pediatric surgery.
Trevor R. Grace, MD, and colleagues found Tylenol, NSAIDs and ice dramatically reduced the number of opioids consumed in the postoperative period after an array of orthopedic procedures in a study. They also concluded that tailoring discharge pain regimens to inpatient opioid consumption reduced physician overprescribing practices. These studies, as well as others that have recently been published regarding the use of opioids after total joint arthroplasty, confirm that we simply do not need to prescribe three to five times the number of narcotics that patients are actually using. Furthermore, orthopedic surgeons need to understand that NSAIDs and Tylenol can result in similar pain relief without the concern of addiction associated with opioid use.
NSAIDs relieve pain
Having undergone hip arthroscopy, herniorrhaphy and rotator cuff repair in the past 12 months, I consumed five Percocet (oxycodone hydrochloride and acetaminophen, Endo Pharmaceuticals) pills of the 105 pills prescribed for me. I found that 400-mg Motrin and 500-mg Tylenol every 6 hours worked just as well as Percocet to relieve the pain associated with these procedures.
Orthopedic departments in hospitals and some private practice groups have developed formal guidelines for prescribing pain medication, opioids and opioid alternatives, and many of them have supplemented the guidelines with programs that help patients manage pain with non-pharmaceutical approaches.
In an article about one practice’s approach to opioid prescribing, Healio.com/Orthopedics highlights one such group, Twin Cities Orthopedics in the Minneapolis/St. Paul area. Look for other articles about other programs and efforts within orthopedics that exemplify how orthopedic surgeons have developed programs that help reduce patient opioid usage in attempts at becoming part of the solution to this difficult problem of physician-induced opioid addiction. Other institutions included in this series are:University of California, San Francisco, Hospital for Special Surgery, and Geisinger.