Ask all patients about opioid use, emphasizing that you are asking because you want to provide them with the best possible care. Explain that previous opioid use can affect pain perception and the need for pain medication, and involve pain management specialists to collaborate on a pain control plan if the patient is using opioids.
Explore This IssueDecember 2017
“Incorporating surgical treatments for someone who already has pain management issues is tricky and requires an interdisciplinary approach,” said Jason Moche, MD, a facial plastic surgeon and assistant clinical professor of otolaryngology—head and neck surgery at Columbia University in New York City.
For decades, we’ve been treating pain with narcotics, and the people at large, when they have pain, they expect a pill. It’s going to take a long time to really change habits and thought processes. —Carl Stephenson, MD
2. The Number of Pills You Prescribe Matters
Currently, there isn’t a lot of uniformity regarding opioid prescribing practices, even within the same medical practice. One physician may write a script for 20 pain pills after a routine surgery; his colleague might regularly prescribe 14 pills to patients undergoing the same exact procedure.
The research, though, shows a clear link between the number of pills prescribed and the likelihood of patients developing dependence. A 2017 study published by the CDC found that patients who get a one-day supply of opioids have about a six percent chance of being on opioids for a year or longer. Patients who get a five-day supply have a 10% chance of using opioids a year after the initial prescription, and patients who receive a 10-day supply have a 20 percent chance of using opioids after a year (MMWR Morb Mortal Wkly Rep. 2017;66:265–269).
“If you give patients a two-week supply, most patients will not become addicted, but a significant number will,” said Andrew Kolodny, MD, co-director of Opioid Policy Research at the Heller School for Social Policy and Management at Brandeis University in Waltham, Mass., and executive director of Physicians for Responsible Opioid Prescribing.
Try to avoid prescribing extra narcotics “just in case,” or to avoid calls from patients over the weekend. According to the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, physicians “should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.”
3. You Can Probably Decrease the Amount of Opioids You Prescribe