POST-OP PROBLEMS

US surgeons are largely ignoring advice to cut back on painkiller prescriptions

The number of opioid-related overdoses has grown steadily over the past decade in the US. This year, the pop-star Prince joined the thousands of Americans whose lives were claimed by overdoses on the class of painkilling drugs that includes morphine, fentanyl, Vicodin, OxyContin, and Percocet.

Opioid painkillers are often prescribed to patients in severe pain, like the kind caused by broken bones, cancer, or serious surgery. These drugs are wonderfully effective because of the way they mute sensations of pain, but also highly addictive because they simultaneously activate the brain’s reward system.

And doctors have been prescribing away. The US Centers for Disease Control (CDC) estimates that in 2012 doctors wrote 82.5 opioid prescriptions for every 100 people—enough for everyone in America over 18 to have their own bottle (pdf, p.2) of pills. This year, the CDC issued new guidelines for doctors issuing painkillers, including a recommendation that they cut back on prescribing them.

But a recent report from doctors at the Dartmouth Hitchcock Medical Center in New Hampshire shows that doctors aren’t really listening to this advice.

The authors of the paper collected postoperative data from 642 outpatient surgeries for partial breast removal, gallbladder removal, and hernia repair. In 581 of those surgeries—more than 90%—doctors prescribed some kind of opioid painkillers, including for almost all of the 281 laparoscopic surgical cases, which require only a small incision.

They then interviewed a subset of 127 patients, with a balanced breakdown of each type of surgery. Patients reported that they actually only took about 29% of the pills they were prescribed. Of the 3,545 total pills doctors deemed necessary, 2,527 were not used to reduce postoperative pain.

These extra pills can be dangerous: either the patient or someone close to that person are more likely to take them to get high. And in high enough doses, opioids can be lethal because they can stop a person’s breathing.

Patients risk addiction whenever they take these painkillers, even as directed—it’s why the US Drug Enforcement Agency classifies them as schedule II drugs, which are still legal with a prescription, but considered extremely dangerous and highly punishable if sold or obtained without one. In 2014, 1.9 million Americans abused prescription painkillers. Popping pills can also lead to heroin abuse: many studies have shown that a sizable portion of heroin users, ranging from 20% to 70%, first abused prescription opioids.

This report looked at just one hospital setting for general surgeries. Other surgeons might prescribe fewer painkillers, and other patients undergoing more extensive surgical procedures may need even more to recover comfortably.

And, of course, even in this case the doctor’s were not trying to harm their patients when they prescribe painkillers. Quite the opposite: The authors of this particular report note that “providers also want to make sure that the pain patients experience from surgery is minimized, so they prescribe enough to satisfy the patient who requires the most opioids.” It’s also more convenient for both doctors and patients if doctors initially prescribe more pills than needed; extra pills to begin with mean no follow up visits just to get more.

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