About two years ago, Michael Englesbe, a surgeon at the University of Michigan's transplant clinic in Ann Arbor, started noticing something disturbing about his hospital's sources of organ donations. "It was like, 'Oh, my gosh, it seems like more and more of our donors, if not the majority, are now overdosed,'" he says. Englesbe and several other surgeons thought about how they might help prevent opioid addiction in the region.
Their solution was a simple prescribing-education program that reduced the number of opioid pills their trainees prescribed, seemingly without leaving their patients in any more pain than before. In a newly published study, Englesbe and his co-workers estimate that, in five months, their program prevented 7,000 excess opioid tablets from being prescribed. Their hope is that, in the process, they averted some opportunities for new opioid misuse. "Overprescribing essentially leaves a lot of pills in the community and that's how a lot of misusers are introduced to it," Englesbe says.
He and his team came up with their guidelines after surveying patients who came to the hospital for its most common surgical procedure, a gallbladder removal. The surgeons found that, after their procedures, patients were getting prescribed an average of 40 tablets of prescription painkillers. The average patient took only six. "There's this big mismatch," Englesbe says. "It was somewhat unclear, the reasons why we were writing so many."
The research team developed new guidelines that suggested hospital staff give out smaller prescriptions and talk to patients about how they should feel after surgery (not in debilitating pain, but sore); the risks of opioid medications; taking non-opioid pain relievers such as acetaminophen or ibuprofen, if possible; and the fact that other people who had the same surgery didn't tend to need a lot of opioids to recover.
After the change, the team surveyed gallbladder surgery patients again. Folks who came in after the guidelines were implemented got a prescription for 15 pills, on average. They used an average of four pills and didn't rate their pain any differently from people who had come in before the change. On average, both groups said that their pain was at a level five, on a scale of zero to 10. "In many ways, it was a successful implementation," Englesbe says.
He and his co-workers are now hoping to take their guidelines statewide, working with the state's Department of Health and Human Services and Blue Cross Blue Shield of Michigan. "I think there will be a move toward opioid minimization, if not even opioid-free surgery, across the United States, in the coming years," he says.