Opioid Epidemic

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The best part about working at an academic institution is that you’re always learning! Generally twice a week, the department hosts a conference that is offered to the ENT residents and PEs (PAs/NPs).

This past Friday, I had the opportunity to sit in on a lecture about the opioid epidemic with an otolaryngology perspective.
Since 2014, more people have died EACH YEAR from drug overdose than the numbers that died in the Vietnam War ( >58,000 people/year).
How does the opioid crisis affect me? 
Personally – I started my public health career interviewing young adults that were diagnosed with hepatitis C. Most of them admit that their addiction began after being prescribed opioids for an injury.
As a PA – Although, I am most involved in pre-op/post-op care and will not be the one directly prescribing opioids, I believe all health care providers are affected and plays a role to end the epidemic.
Did you know that opioids may worsen postoperative recovery, are associated with immune deregulation, delayed wound healing, increased postoperative morbidity, worsens quality of life, prolonged hospital stays, and leads to higher readmission rates!?
How did we get here? – –
  • In the 1990s, pain became the “5th vital sign” (Temp, BP, HR, RR) and many physicians agree that this led to the over-prescribing of opioids.
  • Another possible theory is due to aggressive marketing practices of pharmaceutical companies (Interesting, isn’t it?).
  • SES (Socioeconomic) Factors – opioids are used to treat chronic pain from overuse injuries in blue-collar workers (2/3 of ER physicians prescribe opioids for acute low back pain, even though standard guidelines are physical therapy/NSAIDs)
  • Opioid prescriptions for young people (sports injuries/tonsillectomies)…young people are at greater risk for developing an opioid addiction if exposed at an early age.
FACT CHECK: Surgeons have the 2nd highest rate of opioid prescribing AFTER pain specialists.
Why is this a problem? – –
80% of filled postoperative opioid prescriptions are incompletely used and prescription opioid use leads to heroin use.
Remember the Hippocratic oath, “First, do no harm.”
What are we doing to combat the opioid epidemic?
Mandates are currently underway from the joint commission and medical licensure.
What do we as health professionals need to do?
  • Screen for conditions that increase the risk of opioid therapy
  • Pre-op education on risks of opioids that may lead to…death
  • Prescribing a naloxone prescription for patients that are prescribed >50 mg morphine equivalents/day
  • Multimodal analgesia, work with the anesthesiologist, local infusion of anesthetic prior to incision and at the end of a procedure
  • Minimize dose and duration of post-op opioids
  • Continue to monitor your state’s online drug monitoring database prior to prescribing ANY opioid pain medication
I challenge you to have the discussion at your workplace. Are there any guidelines set in place? If not, how can you create one? If you prescribe, how are you going to have the talk with your patient to make sure they understand the risks?
“It’s time to own this problem, and be part of the solution.”
#Responsibleopioidstewardship

Xx,
Ngan
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