* From the latest edition of the Annals of Surgery, which has been published since 1885…
We are running out of ways to emphasize how dire the opioid overdose crisis has become. In 2015, United States drug overdose deaths exceeded 50,000; 30,000 involved opioids. There were more deaths from opioid overdose than not only from motor vehicle accidents, but also than from HIV/AIDS at the peak of the epidemic in 1995.
The role of surgeons is important for 2 reasons. First, we are likely to encounter many patients on chronic opioids. Older estimates suggest 5% of the general population use opioids chronically. Cron et al found that patients seeing surgeons may have significantly higher rates of use, with 21% of general surgery patients at the University of Michigan Medical Center using opioids at home prior to surgery.
Second, emerging evidence suggests that surgeons are unwittingly enablers of addiction, abuse, and overdosage. Waljee et al5 cite administrative data suggesting that 3% to 10% of opioid-naive patients who receive narcotic prescriptions for low-risk surgery continue to take narcotics up to a year later. Moreover, the vast majority of prescription opiate abusers receive the drugs they use through diversion, most often from family members who have excess pills. And, as Hill et al document, surgeons frequently supply a large excess of pills, with 72% of narcotics prescribed for 5 outpatient procedures going unused. One hundred seventeen of 127 patients they tracked had excess pills; three-quarters retained the pills instead of disposing them. Cauley et al also found, in data from the National Inpatient Sample, that rates of postoperative opioid overdosage among patients undergoing inpatient surgery doubled over the last decade. Surgeons are proving to likely be a significant source of the opioid supply fueling the current epidemic.
* One way to address the problem…
In 2010, however, the U.S. Drug Enforcement Agency issued regulations permitting electronic prescribing for controlled substances.11 Such systems have numerous advantages: they prevent duplicate and forged prescriptions by using 2-factor authentication; reduce dosing errors; cross-reference prescription monitoring program databases; and simplify the prescription process for doctors and patients. Electronic prescribing would make it far easier for surgeons to write smaller prescriptions that meet the needs of 80% of patients, or even 50%, knowing they could remotely order an additional supply if a patient needed it.
The technology is widely available, but few doctors use it. Although 81% of pharmacies are enabled to receive computerized opioid prescriptions; more than 90% of physicians have electronic medical record systems; and most can be enabled for controlled substances—only 8% of physicians are in practices that have enabled that capability and use it.
Doing so is clearly feasible. In March, 2016, New York promulgated stringent opioid prescription requirements, including mandatory use of electronic prescriptions. By then, half of the state’s doctors were already prescribing controlled substances electronically.
* Opioid epidemic: Another drug war failure: Pot, in fact, appears to be saving lives. A 2014 study published in JAMA Internal Medicine found that states allowing medical marijuana had 25 percent fewer deaths from prescription drug overdoses than states forbidding it… Crackdowns have other unhealthy side effects. “When the police shut down a local pill mill, they rarely identify the users and help them get treatment, and heroin and fentanyl dealers are quick to move in to exploit the new business opportunity,” writes New York University professor Mark A.R. Kleiman in the March/April issue of Foreign Affairs. “In 2014, deaths from overdosing on prescription opioids fell, but deaths from fentanyl overdoses almost doubled.”
* Hearing continued for McHenry doctor accused of overprescribing pain pills