The opioid epidemic is here. I’m sure almost everyone who reads this article personally knows someone who has been affected by it. The statistics are staggering.
More than 130 people die from overdoses in the United States every day. That’s more than 47,000 deaths in 2018, according to the Department of Health and Human Services. Now more people are turning to rehabilitation from opioid dependence than from alcohol.
Although heroin is the main cause of the crisis, the increase in the number of prescription painkillers is more than a 50 percent increase in opioid consumption. According to the Centers for Disease Control, more than 17 percent of Americans had at least one prescription opioid in 2017.
Nearly 80 percent of heroin users have previously abused prescription painkillers. It is clear that healthcare providers need to take an active role in addressing this crisis. The Indiana Regional Medical Center is a leader in western Pennsylvania.
Many of these opioid prescriptions begin with surgery. Therefore, we need to find ways to reduce surgery-related pain, find alternative opioid drugs and better teach our patients expectations.
Advances in technology have led to greater accuracy of surgery. This is most noticeable with advances in robotic surgery. Robotic surgery leads to much greater accuracy of operations.
Hospitals on all sides are overwhelmed financially and must do their best to survive. As a result, new alternatives to opioids are often considered too expensive to begin with. I have fought this struggle in other institutions with very limited success. However, the IRMC had a different story.
When data on non-opioid options for postoperative pain management were presented, they were received by the administration, pharmacy, and anesthesia department. They are also very concerned about the consequences of the opioid epidemic for the local community.
Now the non-opioid approach to surgery begins even before the patient wakes up from anesthesia. Randomized, blinded studies showed that analgesia was equal to or better than opioids with non-opioid IV drugs. These drugs are the good old acetaminophen and ibuprofen, Tylenol and Motrin. However, when taken orally, they lose about 30 to 40 percent of their effectiveness. They must first be absorbed from the gastrointestinal tract. The percentage of absorption varies from person to person.
Then all the blood from the intestines drains into the liver. The liver then breaks down medications, especially acetaminophen, before it reaches central blood flow and pain receptors. This is called the “First Pass Effect”.
However, when these drugs are administered intravenously, they bypass both absorption and first-pass problems, with 100 percent of the dose reaching pain receptors. The result is a much higher level of pain relief that most patients report better than opioids. These drugs are given under anesthesia during surgery. As a result, they are in place and work before the patient wakes up after surgery. We then continue to take these medications on a schedule every four hours, alternating intravenous acetaminophen with ibuprofen.
By not waiting for the pain to get out of control and then asking for opioids, we greatly reduce the need for additional painkillers.
Finally, we need to change the health culture in this country. According to the Journal of the American Medical Association, patients in the United States have seven times more prescriptions for opioids prescribed after surgery than patients who have undergone similar surgery in Sweden. Expectations need to be adjusted. It starts in the office during a preoperative visit where expectations can be met. We know that early movement or walking after surgery also speeds up recovery and reduces prolonged pain. The lymphatic system in our body helps remove toxins from the area of damage.
Patients should be involved in their care. Throughout my career, I have made sure that all my patients want to recover as quickly as possible. We can all better participate in our recovery if we know what to expect. Your surgeon should explain your expectations of recovery.
We need to do something about the opioid epidemic. Healthcare providers need to take the initiative, but we cannot do this without the support of the health care system where we provide care. I am proud of the Indiana Regional Medical Center and the support I have received as we continue on our path to opioid-free surgery.