All around the country on April 27 – National Prescription Drug Take-Back Day, as designated by the U.S. Drug Enforcement Agency – thousands of people drove to designated sites all around the country to dispose of unused prescription opioids.
The epidemic created by these drugs and the destructive toll they have taken on Georgia and on our country has been well documented. Piedmont Healthcare is involved in a coordinated effort to reduce the need for and prescribing of opioids in our community so that one day Take Back Day becomes unnecessary.
Among the numerous short-term goals of our system’s Opioids Task Force, which was convened by our system’s CEO in 2018, is to reduce the supply of opioids that the 2 million patients we treat annually receive when they leave our hospitals – whether patients receive those opioids from the Emergency Department or from the Operating Department following surgeries. We are instituting a variety of protocols that take a holistic approach to pain management in the first few days following surgery – the most critical period – to reduce the need for opioid medications in pain management.
Those first few days are when surgical pain is at its peak. Soon after, pain, for the great majority of patients, recedes dramatically and may be controlled with medications that have much milder side-effects. Non-opioid medications and other non-medication alternatives such as massage, heat and cold packs, repositioning, and physical therapy are quite beneficial in helping to relieve pain.
Every specialty is examining and implementing best practices in the effort to effectively relieve pain and reduce our need for these potentially hazardous and highly addictive medications. We are working to integrate these best practices into our system’s Electronic Health Record so that all medical practitioners will have access to these plans for patient care. For patients facing surgery, the effort to reduce pain and decrease complications frequently must begin before the surgery. The broad strokes of those steps are enumerated below.
Prior to surgery, we will implement more protocols involving Enhanced Recovery After Surgery, or ERAS. One definition of ERAS comes from the American Association of Nurse Anesthetists as “patient-centered, evidence-based, multidisciplinary team developed pathways for a surgical specialty and facility culture to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery.”
One example of this is having a patient drink high-carb sports drinks prior to surgery. While this is not necessarily related to pain control, it is associated with features of enhanced recovery – the theory being that the faster and/or better the recovery, the less pain involved. Also, nerve blocks that have a prolonged duration of action may be administered by the anesthesiologist immediately prior to surgery. These nerve blocks last for many hours after surgery and are very effective at reducing pain and therefore help the patient to be mobile much more quickly after surgery. Other efforts may include an exercise plan and patient education about what post-operative care will be required to assure the best outcome and help reduce pain.
Another ERAS tool is to keep patients from becoming overly cooled during surgery. Research indicates that inadvertent hypothermia ranks among one of the most common complications during surgery and has been recognized as a contributing factor to, among other things, patient discomfort. Thus, the simple use of warm blankets can have a salutary effect.
Effective alternatives to opioids such as Toradol are available for pain control in the post-surgery period. Where possible, getting patients to be ambulatory even within a few hours after surgery greatly reduces pain and decreases complications related to surgery. Non-opioid prescription medications such as ibuprofen and/or acetaminophen combined with medications that decrease nerve sensitivity can be used for pain control during and after discharge from the hospital. For many patients, these medications are as effective as opioids without the potential adverse effects that may occur with opioid medications.
With all of that in mind, it is important to note that opioids can still – and will – play a role in pain management for certain patients. At present, they may still be needed in some patients after surgery to assist with pain management but the goal is for the shortest possible period of time. Other uses include those suffering from cancer, painful musculoskeletal injuries, and other chronic painful disease conditions.
What about the person who is already suffering from opioid addiction? It also is the goal of Piedmont Healthcare to educate and help remove the stigma from those suffering from opioid addiction so that they can feel free to seek help. We will work cooperatively with our communities to help direct these individuals to services that will provide the help they need. Patients can become addicted from just a few doses and 100 American’s continue to die daily from opioid overdose related to both prescription and illegal opioids.
The goal of Piedmont Healthcare is to provide safe and effective pain management resulting in fewer doses of opioids administered and prescribed. We also believe that we are taking positive steps to reduce the overall supply of these medications in the community.
Norris Little, M.D., is the chief medical officer of Piedmont Newton Hospital and a member of Piedmont Healthcare’s Opioids Task Force.