The use and abuse of both prescription and illicit drugs has increased dramatically in recent years and has become a major public health concern. According to the Centers for Disease Control and Prevention, the number of overdose deaths involving opioids, both prescription and heroin, has quadrupled since 1999. Coinciding with this increase, the sale of prescription opioids nearly quadrupled from 1999 to 2014. A most alarming result of these practices is the increased accessibility of addictive opioids.
Surgeons have a responsibility to minimize their patients’ postoperative pain while addressing the societal imperative to avoid overprescribing. There has been wide variation in the limits and restrictions placed on prescribers by payors and state legislatures. Many of the proposed policies will have a significant impact on patient safety and the way surgeons prescribe opioids and may expose specific patient populations to unnecessary suffering.
The ACS is committed to helping to prevent opioid abuse and addiction in surgical patients. The College’s guiding principles are as follows:
- Promote the use of prescription drug monitoring programs (PDMPs) through the following activities:
- Set expectation that PDMPs are fully functional and interoperable with electronic health records
- Establish state/federal grant programs to enhance PDMPs
- Reduce barriers to PDMP access by nonphysician licensed independent practitioners and physicians’ designated agents
- Support research and training, developed in collaboration with specialists in pain management, for safe prescribing practices of opioids and nonopioid analgesics through the following activities:
- Identify patients at high risk for opioid addiction, substance use disorder, or an opioid-related adverse drug event
- Establish guidelines for acute pain management of the opioid-addicted patient
- Set expectations and educate patients and caregivers prior to surgery, during discharge, and throughout follow-up
- Provide evidence-based education and evaluation training programs on opioid and nonopioid alternatives for pain management for the entire surgical team—surgeons, residents, and other health professionals
- Strengthen postoperative surveillance by both patients and providers to expand the evidence on use, response to alternative therapies, and potential issues with long-term use in acute surgical and palliative care patients
- Recognize and address issues specific to military veterans by establishing the following programs:
- Fully functional opioid tracking system for Veterans Affairs (VA) patients
- A system to track prescriptions issued at all federal facilities, including the VA, to outside treating providers and pharmacists
- Expansion of the VA Opioid Safety Initiative
- Change the direct relationship between provider reimbursement and patient pain control through the following efforts:
- Detach questions regarding pain management on patient satisfaction surveys from physician reimbursement
- Examine the impact of insurer and state-based government regulations on prescribing practices and patient experience
- Support patient safety legislation that includes the following provisions:
- Exemptions for the postoperative and/or injured surgical patients who are expected to require opioid analgesics for more than seven days
- Exceptions from prescriber mandates for patients undergoing cancer treatment, cancer rehabilitation, and palliative care
- E-prescribing of controlled substances to improve tracking, reduce opportunities for fraud, and limit episodes where patients in pain are without relief
- Partial filling of opioid prescriptions
- Disposal programs to prevent misuse or diversion of unfinished prescriptions
