October is National Substance Abuse Prevention Month. According to CDC data, an average of 207 people died each day from opioid overdoses in the U.S. during the 12-month period ending in April 2021. When opioids are prescribed in the hospital setting, a patient's risk for long-term opioid reliance increases, regardless of whether they had prior exposure to opioids. Patients receiving opioids for short-stay surgeries have a 44% increased risk of long-term opioid use, and over 60% of those receiving 90 days of continuous opioid therapy continue use years later. These figures are staggering, and as medical professionals we must adapt our practice to help prevent opioid misuse in surgical patients.
Countless medical professionals have witnessed patients become addicted to narcotics after surgery. As clinicians, our goal is to return patients to their normal lives, with as little disruption as possible. A critical component of this is educating patients about options for pain control and the potential risks of opioid use during and after surgery. Reducing opioid use can help enhance recovery, reduce complications, allow patients to resume a normal life more quickly, and improve overall patient satisfaction.
We recommend working with all patients to ensure they are active participants in their own recovery. In our practice, teams across our footprint regularly collaborate with surgeons, nurses, and other clinical providers to develop pathways of care that put the patient at the center. This collaboration is part of a larger care program called Enhanced Recovery After Surgery (ERAS) -- a longstanding, proven pathway of care in surgery, providing significant improvements in the quality of care delivered.
One essential component of ERAS is patient education, specifically on pain management. Prior to surgery, patients should consult with a healthcare professional to discuss their procedure and the road to recovery. Information should be presented in a way that patients understand what to expect before, during, and immediately following their procedure.
An important topic to discuss prior to surgery is pain measurement. Pain is rated on a scale from 0 to 10. This scale is subjective in nature, as one patient's "1" might be another patient's "5." It's important that patients work with their clinical provider to develop a personalized recovery plan to optimize pain control and reduce unnecessary exposure to opioid medications.
To that end, another critical element of ERAS is the use of opioid-sparing anesthesia techniques. We accomplish this by using different types of non-opioid medications, such as acetaminophen and ibuprofen. Nerve blocks can also be used to control pain. During a nerve block, anesthesia clinicians place local anesthesia near specific nerves to decrease pain in a particular region of a patient's body. In 2020, our clinicians in one Kentucky hospital cut opioid utilization in half for spine patients by using non-opioid medications and increasing the usage of nerve blocks. Since then, our teams have increased nerve blocks alone by nearly 300% with improved patient outcomes and patient satisfaction.
Another consideration for opioid reduction during and after surgery is eliminating opioid exposure within a patient's home. Studies show that 73% to 77% of surgery patients report storing opioids in unlocked locations and 42% to 71% of opioids go unused after recovery. Loved ones can discover these medications in a patient's home and use or distribute the medications themselves. Following safe methods for disposal of unused opioids are important to prevent unintended use by others.
In April, the FDA announced a proposal that would require opioid medications to be dispensed through prepaid mail-back envelopes in an outpatient setting. Encouraging mail back may be a simple step we can take as providers to ensure our patients have a safe and easy method to dispose of unused medications and lower the risk for misuse in the home. It would also help to foster a productive dialogue about pain management and expectations to ensure patients are active participants in their recovery.
If patients have unused medications, the current FDA recommendation is to drop them in a local drug disposal kiosk, bring them to a permanent take back site, or participate in a take back day. If they do not have access to a disposal site, they can follow FDA instructions for safe, at home disposal.
As clinicians, we must prioritize the use of opioid-sparing techniques in anesthesia, safe disposal methods, and education for our patients on the benefits of these approaches. While we cannot entirely eliminate the pain that follows surgery, we can provide pain management that avoids unnecessary opioid exposure, thus reducing the risk for chronic opioid use. Our goal is the same for all patients: to get them back to everyday life comfortably and with manageable pain.
Desirée Chappell, CRNA, is the vice president of clinical quality for NorthStar Anesthesia. Josh Lumbley, MD, MBOE, is the chief quality officer and SVP of physician services for NorthStar Anesthesia.
Disclosures
Chappell disclosed a role in the speaker's bureau for Edwards Lifesciences and Medtronic, and advisory board participation for Provation.