Between 100 and 150 Americans die every day from an opioid overdose; half of those deaths are related to prescription opioid use, according to the CDC. Opioids now account for more deaths than car crashes and gun homicides combined. Opioid usage has become so prevalent and so troublesome that the president of the United States declared the opioid crisis a national emergency in August 2017.
Explore This IssueDecember 2017
The crisis, some physicians say, has been a long time coming. In the 1990s, medical education and practice focused on alleviating pain. “The thought at the time was that we were undertreating patients with pain and that you could give patients significant amounts of opiates, and by and large, they’d be unlikely to develop dependence,” said Edward Damrose, MD, an otolaryngologist and vice chief of staff at Stanford Health Care in California.
Increasingly, however, clinicians and patients are recognizing that prescription opioid usage can lead to opioid addiction. Prescribing practices are starting to change, but slowly. “It’s like turning a huge cruise ship. For decades, we’ve been treating pain with narcotics, and the people at large, when they have pain, they expect a pill,” said Carl Stephenson, MD, an otolaryngologist in private practice in Alabama. “It’s going to take a long time to really change habits and thought processes.”
Here are six truths to keep in mind while caring for patients:
1. Your Patients May Already Be On Opioids
Otolaryngologists don’t write nearly as many opioid prescriptions as primary care providers, pain management specialists, or orthopedic physicians, but that doesn’t mean you can ignore the opioid crisis. A patient who walks into your office with sinus problems may also be taking an opioid for chronic back pain or an injury, and research suggests that up to 40% of people with head and neck cancer begin taking opioids before surgery (JAMA Otolaryngol Head Neck Surg. 2017;E1–E8). If you don’t ask about—and take into account—previous opioid usage, you could run into complications.
“If the patient needs surgery and you prescribe your usual amount of opioids for pain control, you may be massively underdosing them, and they may go through severe withdrawal,” said Babak Givi, MD, assistant professor in the department of otolaryngology–head and neck surgery at NYU Langone Health in New York City. “We cannot assume that a healthy-looking patient who comes to us for a minor procedure is not taking narcotics.”