Post-Surgical Patients Get Too Many Opioids, Underuse Nonopioid Painkillers
Pharmacists can play a role in helping to stem opioid overuse and abuse. A new study suggests that fewer opioids could be prescribed if orthopedic post-surgical patients were counseled on use of nonopioids painkillers such as acetaminophen and ibuprofen. Find out why it is also important to educate patients on how to safely dispose of unused narcotics.
BALTIMORE, MD – Patients undergoing orthopedic surgery are too often overprescribed opioid products while remaining under-educated about the benefits of non-opioid pain relievers.
That's according to a new article in the journal Anesthesia & Analgesia. Johns Hopkins-led researchers report that a minority of patients undergoing spine and joint surgery combine drugs such as ibuprofen and acetaminophen with narcotics to manage their post-surgical pain.
"We found that a very small percentage of patients use nonopioid medications such as ibuprofen and acetaminophen in addition to opioids to help manager their pain," explained first author Mark Bicket, MD, assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "It's clear we need to empower patients to ask their physicians about nonopioid pain management options, as well as call on prescribers to be more thoughtful of their prescribing practices."
An additional positive effect of managing pain more frequently with nonopioid options is that fewer opioid will be leftover to be lost, sold, taken by error or accidentally discovered by a child, Bicket pointed out.
In this study, he built on past research to further examine what happens to opioid pills after they are prescribed. The study team also sought to determine whether patients used nonopioid medications along with their prescribed opioid prescriptions, as recommended by evidence-based guidelines.
To do that, researchers recruited 140 inpatient adult spine and joint surgery patients at The Johns Hopkins Hospital from August to November 2016. Of the 140 patients in the study, 47% were women, most, 74%, were white and the group had an average age of 56. The majority, 58%, reported a history of chronic pain.
Participants were surveyed through telephone calls so that researchers could assess patient-reported outcomes at two days, two weeks, one month and six months. The study was seeking information on whether the patients had stopped opioid treatment and were in possession of unused opioid pills (primary outcome); how many unused opioid tablets they had after stopping opioids; how often they had used nonopioid pain treatments, and how much they knew about safe opioid storage and disposal.
Results showed that, among patients who stopped opioid therapy, possession of unused opioids was reported by 73% (95% confidence intervals, 62%–82%) at 1-month follow-up and 34% (confidence interval, 24%–45%) at six-month follow-up.
After a month, 46% reported having 20 or more unused pills, 37% had 200 morphine milligram equivalents or more, and only 6% reported using multiple nonopioid adjuncts, researchers report.
The study also notes that, two days after surgery, 82% of patients reported not using nonsteroidal anti-inflammatory drugs (NSAIDs) and 44% reported not using acetaminophen. In fact, only 5% were found to have used both NSAIDs and acetaminophen. After a month, only 6% of patients reported use of multiple nonopioid medications.
At the same time, many patients reported unsafe storage and failure to dispose of opioids at both one-month (91% and 96%, respectively) and six-month (92% and 47%, respectively) follow-up.
"After joint and spine surgery, many patients reported unused opioids, infrequent use of analgesic alternatives, and lack of knowledge regarding safe opioid storage and disposal. Interventions are needed to better tailor postoperative analgesia and improve the safe storage and disposal of prescription opioids," study authors conclude.