What Can a Surgeon Do to Prevent Opioid Abuse

An interesting article titled “The Surgeon’s Roles in Stemming the Prescription Opioid Abuse Epidemic” written by James Hupp appears in the 2016 Journal of Oral and Maxilofacial Surgery (vol. 74, pp. 1291-1293). The article describes the current challenges oral and maxilofacial surgeons are facing when it comes to prescribing opioids. This is because regulators and politicians are getting involved due to their perception of an opioid abuse problem. He mentions that Congress is considering legislation to address prescription drug addiction problems.

The author wants surgeons to remember that there are legitimate reasons for giving patients who have had oral surgery such as wisdom tooth extractions an opioid medication.  Pain that interferes with a patient’s usual routines, their ability to consume enough fluids and calories, or their ability to sleep often requires a narcotic until the pain subsidizes. As such these patients should be prescribed opioids and surgeons ability to do so should not be taken away. Even so the author encourages surgeons to raise one’s threshold for using very potent narcotics, and potentially limit the number of doses prescribed to patients.

In the article the author says

“First, there is more and more data showing that many patients receive more potent and more doses of opioid medications than they need to manage their post-operative pain. Second, it is clear that doctors often prescribe too many doses of narcotics that end up being used by other members of the patient’s family, including children. Third, we are all aware that some patients give away or sell the opioids we prescribe for them. Fourth, many individuals with narcotic addiction were, in part, led to or carry on that addiction using opioids legally prescribed for them by their doctors.”

The author also presents some other facts and data on opioid abuse in the article. For example he mentions that three out of four people abusing opioids get them for a family or friend. He later mentions that doctors could consider steering away from prescribing Oxycodone and instead prescribe codeine. He also encourages doctors to tell patients that the goal of pain medications is not to eliminate all pain but to help so that the patient can still function. He also encourages doctors to educate patients about the problem of family members using the remainder of a narcotic prescription for a non-medical use. He also says that the abuse problem can be incorporated into pain management courses taught to new surgeons and dentists. Further academic surgeons can design and conduct research into prescription medication abuse and other potential drugs to use as alternatives.

The author states

“The didactic discussion of opioids abuse needs to be followed by application of sound prescription writing principles when students and residents are learning to treat actual patients. This will need to include teaching them how to explain to patients who present assuming they will need a prescription of why in many cases it will not be needed. Also students and residents need to be trained how to spot drug-seeking and other forms of adverse drug related behavior.”

It seems that eventually oral surgeons may be limited by politicians by how much opioids then can prescribe to patients. Thus other non addicting medications will have to play more of a role in pain management.

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