Strategies to Reduce Patient Reliance on Opioids Postoperatively

Surgeons across the nation are increasing efforts to reduce their overall use of opioids for the long term treatment of chronic pain post-operatively. The driving force- Curtailing the opioid abuse epidemic, an unfortunate but growing trend.

Well-Documented Risks

An epidemic effecting 5 million Americans, half of all opioid-related overdose deaths in the U.S. have been linked to prescription drugs – not “street” or “recreational” drugs. Opioid use, even short term, is particularly problematic for patients with a history of substance abuse.

Changing Practices

Seeing the effects of this epidemic, many surgeons are taking steps to better help patients manage the healing process without potentiating future substance abuse issues. To that end, treatment strategies have emerged to reduce patient reliance on opioids postoperatively. Some of these methods include:

• A reduction in the use of opioids for the short-term management, including the time period two to three days post-op, to prevent the potential for abuse and misuse.
• Pre and perioperative treatment strategies designed to reduce patient reliance on opioids for moderate to severe post-op pain (commonly the first line of therapy).
• The implementation of patient pain contracts to engage patients in their own care and formally educate them on pain management, compliance, prescription use, and routine drug monitoring.
• ERAS (enhanced recovery after surgery) protocol, incorporating the use of short-acting anesthetics, nonsteroidal anti-inflammatory drugs (Exparel, Pacira), ileus control, invasive monitoring, and intensive care treatment combined with minimally invasive surgical techniques designed to enhance post-op recovery by preventing problems resulting from exaggerated inflammatory reactions to procedures (poor healing, infections, organ dysfunction). This technique has been associated with an improved postoperative length of stay and morbidity and reduced reliance on opioids post-operatively.

A Study in Possibilities

A recent study shows how even simple changes may affect opioid use. In the study, a pink reminder card was included in patient files to encourage hand surgeons to discuss with patients prior to surgery postoperative pain management options, explain the risk of opioids, and recommend alternatives. The card – and subsequent discussions - netted a 15% decrease in opioid prescriptions written. Likewise, a survey of dermatologic surgeons found 64% of surgeons prescribing opioids post-operatively for fewer than 10% of surgical patients.

Looking Ahead

While this is a good place to start in the fight against opioid epidemic, when it comes to chronic pain and workers compensation claims, a true drug utilization review program can also contribute to enhancing the quality of treatment and reducing medical costs. ANS Solutions drug utilization review program through pharmacotherapy review is the most advanced of its kind. To find out more about our effective medical cost containment strategies contact us today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/strategies-to-reduce-patient-reliance-on-opioids-postoperatively/

References

Dunleavy, Brian. Curbing Opioids Postoperatively, an Increasing Focus of Many Surgeons. PainMedicineNews.com; November 26, 2015.

Chronic Pain Treatment: Impacts of Drug-Drug Interactions

Polypharmacy, the use of 4 or more medications simultaneously, is a dangerous but frequent practice for chronic pain patients. Unfortunately, because many patients undergoing chronic pain treatment suffer multiple chronic health issues, exposure to drug-drug interactions (DDI) is a common but unintended result, leading to severe consequences for the physical health of patients, as well as a significantly increased financial burden for all involved: patients, providers, and society.

What defines a drug-drug interaction?

A pharmacokinetic DDI involves two or more drugs interacting in such a way that the effectiveness and/or toxicity of one or more of those agents is affected. Physicians' and pharmacists' track record of identifying DDIs have been shown to be poor in the past, with reliance on electronic record keeping that may or may not link with other physician/pharmacist systems further complicating matters. Identifying DDIs has also been made increasingly difficult by the fact that they may present themselves as an alteration in patient physiology, mimicking almost any clinical presentation including other diseases a patient is under treatment for or the physiological changes of aging. Reports are also inconsistent, with wide ranges: 2–30% for hospitalized patients and 9–70% for ambulatory patients, for example.

Will new studies on DDIs shed sufficient light on the subject?

Five recent broad, foundational studies assessing the health care utilization and associated medical costs of opioid analgesics for patients under 18 years undergoing non-cancer chronic pain treatment were assessed. These studies focused on drug-drug exposure (DDE) which is more easily identified and is strongly linked to increasing the potential for DDIs. Researchers’ results yielded a number of findings related to the potential risks and economic implications of DDIs including:

• That drug–drug exposures are prevalent
• DDIs result in significantly higher and substantial costs when they occur
• DDIS can occur in any age group.
• Physicians should consider ways to limit their patients' exposure to potential DDIs.

What measures are being taken to disseminate information on DDIs?

Further studies are being called for to better understand the pharmacokinetics of DDIs and how the costs of DDIs further contribute to the overall cost of the health care system. In the meantime, clinical awareness of the seriousness and scope of drug-drug exposure and interactions prevents effective control of the situation, thus dissemination of this knowledge is key to a positive outcome. All avenues of the medical community are currently involved, including government FDA research and drug label upgrades on selected medications, physician and patient awareness programs from pharmaceutical companies and nonprofits, and enhancement of technology including more streamlined, accurate, prescription databases.

Suitable alternate solutions can be found that do not expose patients to the risk of DDIs

With the chronic pain population growing, awareness of the issues surrounding DDIs is more important than ever. A well informed physician’s practice can improve safety and the outcome of chronic pain treatment patients through doctor/patient education, careful monitoring of chronic pain patients who take concurrent medications, avoiding the prescription of multiple concurrent medications specifically when opioid analgesics ( i.e. codeine, fentanyl, hydrocodone, methadone, oxycodone, tramadol etc.) are involved. This is an area where the expert medical cost containment solutions of ANS Solutions can help. Our Pharmacotherapy Review Program provides three highly effective stages that not only contribute to lower medical costs in workers’ compensation claims, but greatly enhance the quality of life and care for injured workers.

Find a better path to medical cost containment, contact ANS Solutions today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/chronic-pain-treatment-impacts-of-drug-drug-interactions/

References

Pergolizzi Jr. , Joseph V., Puenpatom, R. Amy, Summers, Kent H., Taylor Jr., Robert Ecomonic Implications of Potential Drug-Drug Interactions in Chronic Pain Patients. Expert Rev Pharmacoeconomics Outcomes Res. 2013;13(6):725-734.