The ongoing crisis of opioid addiction and abuse has thus far been impervious to most efforts to combat it, but a new study offers a promising solution for one of the chief contributing causes of the epidemic: the overabundance of prescribed painkillers in U.S. medicine cabinets.
The research, published in Annals of Surgery, posited that “educational intervention” was all that was needed to get surgeons to cut back on the number of pills they prescribe following a procedure. Though it’s already been well-established that most patients require far fewer pills than they’re provided after surgery, that hasn’t translated into revised approaches at healthcare facilities.
According to Richard J. Barth Jr., MD, co-author on the study and chief of general surgery at Darthmouth-Hitchcock Medical Center, the absence of suggested protocols is responsible for the slow shift in pill counts.
“There weren’t really operation-specific guidelines out there before,” Barth told The Washington Post. “Doctors are very data-driven, and if there are specific guidelines, people are going to follow them.”
The study concentrated on five outpatient surgeries routinely performed at Dartmouth-Hitchcock: partial mastectomy (PM), PM with sentinel lymph node biopsy (PM SLNB), laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), and open inguinal hernia repair (IH).
When researchers examined data from prior procedures, they determined that patients were using fewer than 30 percent of the pills prescribed to them to address post-surgical pain. Guidelines were drawn up that cut pill quantities in half. Patients were also encouraged to try nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen before reaching for the opioids.
The researchers then surveyed 246 patients who underwent one of the five procedures under the new guidelines. Even though the number of pills prescribed dropped by 53 percent, one one patient required a refill.
In Barth’s view, the results should shift how surgeons provide assistance to their patients in the recovery process.
“Most doctors say: ‘I want to take care of their pain, and I don’t want them to have to come back and get a refill. So I’m going prescribe them a lot,’ ” Barth told the Post. “The problem is there is a lot of cost to society.”