Dr. Jeffrey Gadsden’s opinion piece, titled “Address Overlooked Starting Gate to Opioid Dependence,” was posted online and featured in Sunday’s edition of The Herald-Sun on October 11, 2015. Read the full story below…
It is clear we are in the wake of a deadly prescription drug epidemic that is touching cities, rural counties and suburban neighborhoods across the country, including in our very own home state of North Carolina, where unintentional poisoning deaths from opioids have increased over 300% since 1999.
Policymakers at the national and state level are working fervently to slow the cycle and resulting swell of this crisis, placing greater legislative emphasis on new opioid formulations to help curb abuse; prescription drug monitoring programs to provide better insight into patients’ controlled substance history; the use of naloxone to reverse overdose effects in life-threatening situations; and the development of more robust rehabilitative services to aid in the addiction recovery process.
And while these initiatives are critically important to combatting the epidemic, there is one imperative often glaringly missing from public discourse—minimizing the introduction of opioids all together by limiting (or eliminating) avoidable exposure.
Implementing this concept is perhaps more difficult when treating chronic pain given the absence of effective alternatives. However, when it comes to treating acute postsurgical pain—which is often a “starting gate” for long-term use, abuse, and dependence—the “opioid-first” approach is no longer necessary, appropriate or safe.
Annually, more than 70 million patients receive opioids following surgery, 2,3 and research shows us that approximately one out of every 15 become long-term users4,5. Fortunately, the increased use of multimodal non-opioid therapies such as anti-inflammatories and acetaminophen, combined with regional anesthesia techniques and more recently long-acting, non-narcotic injectable analgesics, have enabled us to control postsurgical pain for several days with minimal or no need for opioids.
As a practicing anesthesiologist at Duke Medical Center, I’ve seen firsthand the impact of a postoperative approach that moves opioids away from the frontlines of pain control. Reducing or eliminating their use not only curbs risks of long-term use and addiction, but also reduces the risk for serious events such as respiratory arrest, improves patients’ recovery experience, accelerates rehabilitation, and leads to shorter hospital stays.
As such, I am encouraged to see hospitals across the country embracing a patient-centered approach to postop pain management. The road to reducing our reliance on opioids is a long and challenging one, but the path to weaning ourselves from opioids after surgery is well paved and deserves closer inspection.
Jeff Gadsden, MD, FRCPC, FANZCA is an associate professor and practicing anesthesiologist at Duke Medical Center.