While Congress is seeking restrictions on opioid prescriptions, the American Medical Association reports that the number of such prescriptions is decreasing.
But the statistics are still startling:
- Every day, more than 115 people in the United States die after overdosing on opioids.
- Nationally, one-third of all patients addicted to opioids took their first opioid medication post-surgery.
- Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
Opioids are a class of drugs that include heroin, as well as synthetic opioids such as fentanyl and pain relievers available legally by prescription, such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others, according to the National Institute on Drug Abuse (NIH).
Congress is seeking legislation that would put a three-day limit on initial opioid prescriptions for acute pain, and is part of the proposed Comprehensive Addiction and Recovery Act 2.0 introduced last February by a bipartisan group of senators that is a follow-up to the Comprehensive Addiction and Recovery Act signed into law in 2016, according to ModernHealth magazine.
What are doctors prescribing instead of highly addictive opioids?
DailyNorthShore asked Dr. Jason Koh, director of the NorthShore Orthopaedic Institute and chairman of the Department of Orthopaedic Surgery.
Dr. Koh grew up in Northbrook and is a nationally recognized expert on knee, shoulder and elbow reconstruction and hip arthroscopy. He serves as team physician for the Chicago Fire major league soccer team.
“As orthopaedic surgeons, we’re very conscious of the fact that opioid prescriptions are really dangerous. And as an overall organization we’ve been on the forefront of trying to get people controlled in terms of these kind of medications,” he said.
Dr. Koh explained that orthopaedic surgeons are interested in avoiding opioids because they have an addictive potential and many side effects that include nausea, constipation, dizziness and sedation.
“We want many of our patients to be up and active because that’s the purpose of these surgical procedures,” he said.
Fortunately, many ortho surgery procedures are now done safely without the need for narcotic medication.
One example of a new medication for pain is peripheral nerve blocks, which Dr. Koh equated with the numbing medication that dentists use.
“We’re using more selective blocks where you can actually target more of the sensory nerves,” said Dr. Koh. “We use a combination of medications called multi-modal pain management.”
Multi-modal drugs are non-narcotic pain medications such as acetaminophen, gabapentin, and anti-inflammatory drugs.
Dr. Koh added that multi-modal pain medication, long-lasting regional anesthetic blocks, and the use of cold therapy have been used in orthopaedics for years. Cold therapy provides relief by decreasing some of the pain and swelling after surgery.
“Our pain control has advanced to the point where patients are alert and comfortable enough that after a knee or hip replacement they’re able to get up and walk with some support and go home the same day,” said Dr. Koh.
He credits Dr. Ravi Bashyal for leading the progress in that area.
“It’s a select group of patients who are able to do that, but hopefully we can continue to extend that kind of rapid release of pain, restoration and function to a significant group of patients,” Dr. Koh added.
NorthShore University HealthSystem implemented an Enhanced Recovery After Surgery (ERAS) program in 2016 for colorectal surgery, but Dr. Koh explained that NorthShore will soon be one of the first places in the country to start implementing ERAS for certain types of spine surgeries.
ERAS was developed in Denmark in the 1990s and was designed to optimize pre-operative, intra-operative, and post-operative patient care. A key component of ERAS is patient education.
“There’s recent data showing that if patients are properly educated about different ways to have pain control and the risk of opioids after surgery, that will cut their narcotic use by 50 percent and get them off that narcotic after a surgical procedure much more quickly,” said Dr. Koh.
But surgery isn’t always the best option.
“Our goal in orthopaedics is to restore people to effective, pain-free lives, and the majority of patients we treat on a day-to-day basis are without surgical procedures, ” he said.
Dr. Koh often prescribes physical therapy to eliminate substantial pain by strengthening the knee, hip or back.
But for patients where surgery is clearly necessary and the joint is completely “worn out like a flat tire,” joint replacement on average provides 20 plus years of pain relief, according to Dr. Koh.
Dr. Koh was thrilled when some of his patients who were in severe pain before their shoulder replacement surgeries only felt the need to take Tylenol or Advil within a day or two after having the procedure.
“It’s great to help patients get out of pain and resume active lives without the use of narcotics or other pain medications,” he said.