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Post-Surgical Opioid Prescriptions Safely Cut

Pills and capsules

(stevepb, Pixabay)

7 Dec. 2018. A cancer center reduced its opioid pain prescriptions for surgery for a year, without patients reporting more pain, complications, or requests for more pills. A team from Roswell Park Comprehensive Cancer Center in Buffalo, New York reports its findings in today’s issue of the journal JAMA Network Open.

Researchers led by Roswell Park cancer specialist Emese Zsiros are seeking alternatives to wholesale prescriptions of opioid-based medications to manage pain of patients following surgery. The problem of opioid addiction is intertwined with relief and management of pain, for which opioid drugs are usually prescribed. Opioids work by reducing the intensity of pain signals to the brain, particularly regions of the brain controlling emotion, which reduces effects of the pain stimulus. Examples of leading opioid prescription pain medications are hydrocodone, oxycodon, morphine, and codeine. Heroin is also considered an opioid.

Despite state laws in New York restricting prescriptions of opioid pain pills to 7-day supplies, cancer patients are exempt from these rules, which led Zsiros and colleagues to examine Roswell Park’s own policies for a solution. Beginning in June 2017, the cancer center changed its opioid pain prescription policies for patients undergoing gynecologic and abdominal surgery, eliminating or sharply reducing the amount of opioid medications. Individuals having ambulatory or minimally invasive surgery received no opioids, while those undergoing major surgery received only a 3-day supply, with exceptions for those patients needing more than 5 doses while in the hospital. All patients received non-opioid pain medications, such as ibuprofen or acetaminophen — Advil or Tylenol, respectively — as needed for 7 days.

Beginning in June 2017, the Roswell Park researchers tracked women having gynecologic and abdominal surgery under these prescription policies through June 2018. In that time, 605 women had one of these surgeries under the new policies, and the team compared the results to 626 women receiving the same procedures in the 12 previous months, particularly the 60-day period immediately before, during, and after the surgery.

As expected, the number of opioid pan pills prescribed dropped drastically after the new policies took effect. With ambulatory surgery, for example, patients received about 14 pills on average before the restrictions, compared to an average of 0.2 pills per patient after the new policies were implemented.

The results show the amount of reported pain by the patients was about the same for patients under the restrictive prescription policies as before the policies went into effect. In addition, more than 8 in 10 patients (84%), both before and after the restrictive policies went into effect, did not request more pain pills. And according to the state-wide opioid tracking system in New York called I-STOP, the researchers confirmed patients did not get opioid medications elsewhere.

Zsiros notes in a Roswell Park statement that, “our study clearly shows that patients can recover from major surgery just as well with over-the-counter pain medications such as ibuprofen or acetaminophen and minimal or no opioids, with no increase in pain or postoperative complications — and without the side effects of opioids, such as nausea, constipation, sluggishness and dizziness, as well as the risk of long-term opioid use, abuse and diversion.”

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