The opioid epidemic, a 360 degree view
As a group, orthopedic surgeons have always taken pride in knowing we can offer patients surgical interventions with the intention of returning them to their activities of daily life — at full function.
But over the past 15+ years there has been an issue silently growing within medicine and orthopedics and today it grabs the headlines. This issue alarms physicians and patients alike. This issue is collectively referred to as the opioid epidemic.
Orthopedic surgeons are among the top prescribers of opioid medications in the US. A treatment category once lauded for its role in managing pain is now a drug class scrutinized for its necessity and appropriateness.
As the Midwest's largest independent orthopedic practice, at Illinois Bone & Joint Institute (IBJI) we are embracing our duty to be forthright in taking a stand on today's opioid crisis, and doing what is best for our patients.
Today, an estimated $78.4 billion dollars is being spent annually for medical treatment, lost productivity and the added health insurance and criminal justice costs of opioid abuse and dependency. Every day in the US between 50 and 100 Americans die from opioid overdoses.
In addition, approximately 70 percent-90 percent of patients undergoing surgery reported unused opioids. Mindfully storing and discarding excess opioids is an important component to the crises.
In looking at the history of the issue, multiple parties have contributed to where we stand today, not the least of which are the pharmaceutical manufacturers. Pharma has lobbied to make pain a vital sign.
Regulating opioid marketing, distribution, and consumption is needed. The pharma industry is facing a deluge of lawsuits claiming harm to patients from misleading marketing and inadequate addiction risk disclosure.
One might even assert that we could point to changes in our culture since the advent of technology. If we won't wait 5 minutes for a document to download, or Web page to load, we are likely just as impatient for pain to subside.
The time has come for all of us that impact the crisis to be introspective and adjust our expectations. Overall, we have found that the most effective way of managing a patient's pain is to have a frank discussion about what can be expected post-surgery. Simply put, there will be pain.
But, we can use post surgical protocols that drastically limit the amount of opioid use and combine a number of non-opioid therapies to help manage the pain. Managing expectations and having forthright discussions with your patients is the key to success for post surgery pain management.
Equally important is holding to a stringent opioid prescribing policy (which we do have at IBJI).
For example, if and when an opioid is indicated, limiting the treatment duration (days not weeks), as well as the minimum effective dosage and pill count. Further, physicians must use the database tools available to them and identify misuse by patients reported on monitoring systems.
Strong leadership is needed among physicians and within the medical community to change public opinions regarding treatments for pain, to reduce opioid consumption, and to end the horrible deadly epidemic that we are currently facing.
• Dr. Peter Hoepfner is a board-certified orthopedic surgeon at Illinois Bone & Joint Institute.