As the opioid overdose epidemic has blazed across the U.S., the surgical community unwittingly fueled the fire. Seeking to alleviate patients’ pain, and not fully appreciating the risks they posed, we have prescribed these painkillers in excess.
Liberal use of opioids for postsurgical recovery has led to drug dependence and addiction. Roughly 1 in every 16 surgical patients who were prescribed opioids were still getting the drugs three to six months later, University of Michigan researchers found. The larger the opioid prescription, the greater the chance of long-term use.
In other cases, the pills—morphine, oxycodone and hydrocodone—go unused by the intended patients. They sit in medicine cabinets, sock drawers or shelves, a reservoir of painkillers that are vulnerable to abuse by family or friends. Led by Johns Hopkins pain physician Mark Bicket, colleagues and I recently reported that the vast majority of surgery patients have leftover opioid pills, and hardly any of these patients dispose of the pills properly. About 54% of people who misused prescription opioids say they obtained them from a friend or relative—either with or without that person’s knowledge. It’s no surprise that three of every four heroin users today were first hooked on prescription opioids.
More than ever, patients and providers need to have open, frank conversations about pain. What level of discomfort should be expected after a procedure? What are the options for managing it? How might the patient’s characteristics, such as mental-health history, affect their pain level or likelihood of becoming addicted?