Dear Orthopedic Surgeons,
How many news reports, stories of overdoses do you need before you stop prescribing one and two months of highly addictive opiates? Do you orthos live under a rock? Have you seen the news? Eighty percent of the global opioid supply is consumed in the United States. That’s prescribed medication.
Stories after stories that are all the same theme. “My son had surgery, became addicted and died from overdose.” Most everyone has heard. Why haven’t you? Is no one speaking about this at your conferences? The oral surgeons have caught on. The primary care doctors have, too. Why haven’t you guys?
I’ve talked to no fewer than 6 people who in the past 3 months have had knee and/or rotator cuff surgery and all of them have come home with so many pill prescriptions, they could have set up a pill mill. Most have mentioned 60 days of opiates. This is even after they said they told their surgeon they had plenty.
It’s not up to you to ‘cure’ pain but to set expectations. How about having a conversation with your patients on alternatives? At the very least no one should have more than three days of opiates yet you still hyper prescribe.
Short term means no more than three days.
With a 10-day supply of opioids, 1 in 5 become long-term users
Seven million will become addicted this year due to hyper-prescribing opiates. So as they go in and out of rehab and detox they’ll have great knees! What’s more important that that?
Yeah I’m mad. And I’m not the only one.
All of us who’ve lost a child to overdose, and in my case a suicide, lost their child due to opiate addiction fueled by big pharma and over prescribing–the large majority of whom became addicted after a surgery. Or someone else’s surgery and leftover medication.
I can understand that early on you didn’t know.
I can understand that you were encouraged to treat pain as the “fifth vital sign.”
But that has changed and it was not recent! You’ve changed your surgical techniques. Why can’t you change your prescribing habits?
“When patients get an initial opioid prescription that’s just a one-day supply, they have about a 6% chance of being on opioids for a year or longer. But if that first prescription is for a 3-day supply, the probability of long-term use starts inching up. With an initial 5-day supply, the chance jumps to about 10%. With a 6-day supply, the chance hits 12%. With 10-day’s worth, the odds of still being on opioids a year later hits roughly 20%. And the friends I spoke of had 60 days!”*
If you have stopped prescribing 30-day supplies of opiates
If you are an orthopedic surgeon and you have stopped giving patients marathon prescriptions following orthopedic surgery, post here and tell us about it. Thank you if you have curbed your prescribing habits due to this epidemic.
Help us understand why so many of your colleagues have not caught on. Because I don’t get it. And how can we reach them because it doesn’t look like they listen to the news. Can we put signs on the golf courses? Give us some ideas. Please.
Sincerely,
A mom who has seen too much death from this epidemic
Patients -If you have gotten a prescription of 30 days or more of opiates following orthopedic surgery, post here and tell us about it! Hell, if you’ve gotten them from any kind of doctor, leave a comment!
Lecture your doctor when they give you this many. If they hear it from enough patients, they’ll stop. Be proactive.
A few sources:
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With a 10-day supply of opioids, 1 in 5 become long-term users*
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A Joint Effort: A Provider’s Guide To Orthopedic Pain Options
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Plan Against Pain
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American Pain Society Publishes Clinical Practice Guideline for Post-surgical Pain Management
Yes! I had a breast cyst removed in 2010 and I went to the doctor a week before for a final review. She said, “Oh you must be here for pain meds for post surgery,” which I hadn’t even considered up to that point. I walked out with a 10 day supply of Percocet and I didn’t even need it. Absolutely zero pain post surgery. I can only imagine that Motrin would have done the trick had there been any problems. I didn’t ask for Percocet, didn’t want it, and didn’t need it – insane.
I certainly hope they’ve changed guidelines since 2010.
Amen. My mom has had lots of orthopedic surgery and she could open a pharmacy – she is in constant pain, but the amount of meds she is on, is mind boggling. I sent the email to share with a brand new orthopedic surgeon…….
Thank you. It’s insane that so many are still handing these out like they are candy!
Anne Moss–unfortunately, change is slow when it comes to health care practice. I do think it is changing though. I am currently seeing an orthopedic physician and opiates never came up. I am being treated with Neurontin which has been very effective. I told him, after the fact, that I lost my son to a heroin addiction and that opiates would not be an option for me. That being said, joint replacement is very painful and there is a need for short term opiate use. The operative word being “short term”. As an advocate, I take every opportunity to educate any prescriber I come in contact with re: opiates and benzos–I tell our story. It is a long and frustrating process and much of the responsibility falls on the patient–that’s why we are tasked with educating the public about the danger of long term opiate use. We are making a difference and must keep doing what we’re doing! Four years ago when Mark died, there was nothing in the media and addiction was not a word that was discussed. Look how far we’ve come! Thank you, Anne Moss, for being a warrior fighting the opioid epidemic!
Thank you Kathy! We need more people saying something
I really hope physicians will see this and will comment. We need to hear from them as well. Having worked in hospice all those years we had many patients with massive amounts of (much needed) pain meds. Diversion was surprisingly rare, although we did have times where we had to put lock boxes for the meds in homes, etc. And at the time of death the nurse would destroy all meds left and I, an aide or even a family member would observe the process and sign off on it. We made sure to destroy every hospice-ordered med and would destroy any other natcotic in the home that was the patient’s with family permission. That could be a little trickier if there was someone wanting to use it themselves, but more often than not the family agreed to getting rid of everything. So important, especially with the “big guns” that were often in play for patients with intractable pain at end of life.
What a great example Amy. So there is a process out there! Thank you so much