bottle of pills. 3 Opioids account for more than
one-third of the prescriptions surgeons write,
and 70 percent of patients who have never used
an opioid and undergo a surgical procedure fill a
prescription within one week of an operation. 6, 7
It makes sense that surgeons would prescribe
opioids with some frequency. Surgeons perform
procedures that are painful. Helping to control
the acute pain that our patients experience is a
professional and moral imperative. Moreover,
national professional organizations, including
The Joint Commission, have focused on addressing the pain of postoperative patients, in part by
encouraging opioid-based pain control. Nevertheless, these prescriptions carry risks, which
include chronic usage, addiction, and overdose.
In the midst of this public health crisis, surgeons
have a major responsibility to understand and
mitigate the risks associated with prescribing
opioids and to consider how they can be part
of a broader solution. This article summarizes
some of the actions that individual surgeons can
take, the role of health care systems in effecting
change, and the steps the American College of
Surgeons (ACS) is taking to address this crisis
by assisting surgeons as they help their patients
avoid drug addiction.
Individual strategies to combat
the opioid epidemic
First, we must be aware of the existing
resources to help curb opioid overuse. Current
mechanisms for monitoring, counseling, and
treating patients across the continuum of care
can help minimize risk to our patients and our
The surgeon’s role in addressing the opioid epidemic starts during the preoperative period by
setting patient expectations and assessing the
potential risk for opioid misuse or addiction. 8
A candid preoperative discussion with patients
The ACS is responding to the opioid abuse problem
on multiple levels, including advocacy, surgeon-prescriber education, and patient education.
Overall, ACS advocacy efforts in this area seek to reduce
the abuse of prescription opioids and encourage continued
research into nonopioid pain treatments and other alternative
remedies. Following is a summary of the key issues that are
currently being addressed by the College’s advocacy team:
• PDMPs. To reduce variability across the states, the ACS
strongly supports the use of governmental grant funding
to enhance PDMPs, to make these registries accessible
to appropriate members of the health care team, and to
make them interoperable specifically with EHRs.
• Prescribing limits and practices. The limits and restrictions
placed on prescribers vary widely from state to state. The ACS
asserts that medical decisions should be left to the prescribing
physician and that limits should not affect patient care. The
ACS supports provisions allowing the partial filling of opioid
prescriptions and encourages states to implement disposal
programs to prevent misuse of unfinished prescriptions.
• Veterans’ issues. As noted, the Department of Veterans Affairs
(VA) reports that veterans are twice as likely as non-veterans to
die from accidental opioid overdose. The ACS supports a fully
functional opioid tracking system for VA patients, and believes
that prescriptions issued at all federal facilities, including the VA,
should be trackable to outside treating providers and pharmacists.
• Research funding. The opioid crisis cannot be solved
overnight and surgeons must continue to study options
for treatment and prevention. The ACS supports increased
governmental research funding for drug addiction and
treatment programs and for nonopioid pain management.
• Reimbursement and payment. In some cases, pain scores form
parts of quality measures used for payment or reimbursement.
While there is conflicting evidence as to whether this policy has
an impact on the opioid crisis, the ACS believes this correlation
is an inappropriate way to value quality or payment.
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