Understanding why physicians from various areas of expertise prescribe opioids helps the medical community as a whole combat opioid abuse, misuse and overdose. Even though emergency physicians are not likely to prescribe opioids to discharged patients, doctors from other medical fields are contributing to the opioid epidemic at a higher rate.
Published in The Journal of the American Academy of Orthopaedic Surgeons (JAAOS), a new report found that orthopedic surgeons are prescribing opioids at an alarming rate. The study, which took a look at the country’s opioid epidemic and its impact on orthopedic care in 2009, revealed that orthopedic surgeons are the third-highest prescribers of opioid prescriptions among physicians in the United States (7.7%). This ranks them behind primary care physicians (28.8%) and internists (14.6%).
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PHARMA & HEALTHCARE 5/12/2015 @ 7:50AM |1,431 views
Orthopedic Surgeons Largely Contribute To Opioid Epidemic, Study Reveals
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Understanding why physicians from various areas of expertise prescribe opioids helps the medical community as a whole combat opioid abuse, misuse and overdose. Even though emergency physicians are not likely to prescribe opioids to discharged patients, doctors from other medical fields are contributing to the opioid epidemic at a higher rate.
Published in The Journal of the American Academy of Orthopaedic Surgeons (JAAOS), a new report found that orthopedic surgeons are prescribing opioids at an alarming rate. The study, which took a look at the country’s opioid epidemic and its impact on orthopedic care in 2009, revealed that orthopedic surgeons are the third-highest prescribers of opioid prescriptions among physicians in the United States (7.7%). This ranks them behind primary care physicians (28.8%) and internists (14.6%).
Study co-author Dr. Brent J. Morris, a shoulder and elbow surgeon at Lexington Clinic Orthopedics, said in an interview that there are a variety of reasons why orthopedic surgeons prescribe opioid pain medications to patients. “Orthopedic injuries including broken bones can be very painful and may require casting or surgery to treat and these are often treated with an opioid pain medication during the initial recovery period,” he said.
“Examples of these types of injuries include hip, shoulder, elbow, wrist, and ankle fractures among others,” Morris said. “It is also very reasonable to use a short course of opioid pain medications to help with the recovery following surgery.”
Prescribing opioids, however, isn’t always the best option for a patient. Deciding whether or not to prescribe one isn’t an easy task for any orthopedic surgeon — or at least it shouldn’t be. “It is important for physicians to reassure patients that they intend to control their pain but emphasize the importance of doing so in a responsible manner,” he said. “Part of this responsibility involves minimizing the use of opioids whenever possible. Good communication between providers and patients is the key in setting expectations regarding pain control and the role for non-opioid treatments.”
Non-opioid alternatives for managing a patient’s pain include: over-the-counter medications like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Another alternative to treating and managing pain in orthopedic pain is nerve blocks. Morris said they’re typically used in conjunction with surgery to limit additional pain following surgery.
Study author Dr. Hassan R. Mir, associate professor of orthopedics and rehabilitation at Vanderbilt Orthopaedic Institute, said patients may face adverse effects from continued opioid use. “Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large,” Mir said.
“Furthermore, pain control is an important determinant of patient satisfaction,” Mir added. “Physicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. Most patients truthfully represent their levels of pain, but unfortunately, a small percentage of patients use opioids non-therapeutically and ‘doctor shop’ for additional opioids, making this a delicate balancing act for orthopedic surgeons.”
Nearly every state in the country has implemented a prescription monitoring program (PMP) to assist physicians with tracking prescriptions for controlled substances. These policies can assist physicians with decreasing opioid prescriptions for musculoskeletal pain. Several other areas for potential research include alternative multi-modal pain control regimens, clinician education, patient education, electronic health record utilization and clinical practice guidelines.
“It is important for orthopedic surgeons and patients to understand the detrimental effects of opioid use on clinical outcomes across the spectrum of orthopedic subspecialties,” Mir said. “Opioid use has been associated with worse outcomes after work injuries, total knee arthroplasty, reverse shoulder arthroplasty, and spine surgery.”