ACS Bulletin - August 2017

| 37

by nonmedical personnel such as police officers is permitted under legislation passed by the Illinois General Assembly in 2010. Funded through private donations, grants, and local revenues, the program resulted in 145 “saves” from opioid overdoses in 2016.39 Individual surgeons, like Dr. Jorgensen, are working tirelessly throughout the U.S. to eradicate the source of diverted drugs by encouraging careful prescribing habits and competently treating the patients most deeply affected by opioid addiction.

Fellows of the American College of Surgeons (ACS) have been instrumental in leading efforts to prevent and treat the epidemic. Atul A. Gawande, MD, MPH, FACS, a general and endocrine surgeon, Brigham and Women’s Hospital, Boston, MA, and a leader in the discussion of surgical quality improvement, recently weighed in on the importance of surgical leadership in controlling the opioid crisis. 40 For example, although all states allow electronic prescription writing for opioids, less than 10 states require it, and more than 90 percent of physicians’ practices do not use electronic prescriptions for these drugs. Dr. Gawande exhorts surgeons to take the lead in the implementation of electronic opioid prescriptions, even without a government mandate.

Jennifer F. Waljee, MD, MPH, MS, FACS, assistant professor, plastic surgery, and Michael J. Englesbe, MD, FACS, associate professor, transplant surgery, University of Michigan, are using grant funding to explore innovative ways to reduce excess opioid prescriptions and subsequent diversion. Through the Michigan Opioid Prescribing Engagement Network (also known as Michigan-OPEN) 41, Drs. Waljee and Englesbe are promoting preoperative discussions with patients regarding postoperative pain expectations, organizing the collection of excess opioid medications, and educating surgeons to prescribe fewer opioids. 6 Drs. Waljee and Englesbe also recently published their research showing 6 percent of opioid-naive patients (no opioid prescriptions filled between one to 12 months before an operation) were still taking opioids more than 90 days after a surgical procedure. 42 By identifying patient-level risk factors for persistent postoperative opioid use, such as tobacco use, anxiety, depression, chronic pain, and others, these surgeons are contributing to a deeper understanding of the opioid epidemic. This research is crucial in advocating

11. Veterans Health Administration, United States Department of Veterans Affairs. Pain as the 5th vital sign toolkit. October 2000. Available at: www. va.gov/PAINMANAGEMEN T/docs/Pain_As_ the_5th_Vital_Sign_Toolkit.pdf. Accessed April 30,

2017.

12. Baker DW. History of The Joint Commission’s pain standards: Lessons for today’s prescription opioid crisis. JAMA. 2017;317( 11):1117-1118.

13. Compton WM, Boyle M, Wargo E. Prescription opioid abuse: Problems and responses. Prev Med (Baltim). 2015;80: 5-9.

14. Rutkow L, Chang HY, Daubresse M, Webster DW, Stuart EA, Alexander GC. Effect of Florida’s prescription drug monitoring program and pill mill laws on opioid prescribing and use. JAMA Intern Med. 2015;175( 10):1642-1649.

15. Jones C, Paulozzi L, Mack K. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use: United States, 2008–

2011. JAMA Intern Med. 2014;174( 5):802-803.

16. Muhuri PK, Gfroerer JC, Davies C. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review.

August 2013. Available at: www.samhsa.gov/data/ sites/default/files/DR006/DR006/nonmedical-pain- reliever-use-2013.htm. Accessed June 21, 2017.

17. Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S.,

2007–2012. Am J Prev Med. 2015; 49( 3):409-413.

18. Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD. Opioids prescribed after low-risk surgical procedures in the United States, 2004–

2012. JAMA. 2016;315( 15):1654-1657.

19. Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: A retrospective cohort study. Arch Intern Med. 2012;172( 5):425-430.

20. Edlund MJ, Martin BC, Russo JE, DeVries A, Braden JB, Sullivan MD. The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: The role of opioid prescription. Clin J Pain. 2014; 30( 7):557-564.

21. Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use: United States, 2006–2015. MM WR Morb Mortal Wkly Rep. 2017; 66( 10):265-269.