receiving particularly high doses of opioids (greater than 50 morphine milligrams equivalents daily or approximately 10 tablets of
5 mg hydrocodone daily), the U.S. Surgeon General recommends
offering a naloxone prescription for accidental overdose. 14
Proper medication disposal can have a major effect on decreasing
the opioid epidemic. Among persons ages 12 or older in 2012–2013
who used pain relievers that were not medically necessary in the
past year, 53 percent obtained the drug from a friend or relative
for free, and 11 percent bought the drug from a friend or relative.
Another 21 percent reported that they got the drug through a prescription from one physician. An annual average of only 4 percent
of these individuals obtained pain relievers from drug dealers or
other strangers, and 0.1 percent bought them on the Internet. 3
Health system strategies
Individual efforts to combat the opioid epidemic are critical and
can help prevent misuse among the thousands of patients each surgeon treats annually. Still, an improvement in the broader health
systems can facilitate large-scale improvements across our profession. First, while PDMPs have increased dramatically in number,
they are not standardized and are poorly integrated into existing
workflows. As a result, checking PDMPs is cumbersome, time-consuming, and may yield incomplete information. Integration
of PDMPs into hospital electronic health records (EHRs) could
greatly improve feasibility of checking patterns of patient opioid
use and thereby increase utilization.
As noted earlier, each state has its own set of laws governing
what type of drug use data are available, what type of prescriber
can access the PDMP, and how the data are shared. An ongoing
push toward standardized databases with the ability to share information across state borders is essential to ensuring surgeons have
access to accurate information. Furthermore, for these registries to
maintain information that is beneficial for patient care, it is essential that they not be used for law enforcement purposes.
The U.S. health care delivery system has entered a state
of near constant reform, with variable, ever-changing reimbursement schema. In recent years, the trend has been toward
pay-for-performance measures. Although the financial incentives
for treating pain are extremely limited, some providers still are
concerned that they are being paid in part based on their ability
to reduce patient pain. 15 Thus, as pay-for-performance measures
continue to develop, policymakers must take steps to ensure that
these metrics do not rely on overly proximal measures of patient
1. Park A. The story behind the viral photo
of an opioid overdose. Time. Jan 24, 2017.
Available at: time.com/4634809/photo-
opioid-addiction/. Accessed May 18, 2017.
2. Ohio Department of Health. 2014 Ohio
drug overdose data: General findings.
Available at: www.healthy.ohio.gov/-/
REPORT--- 5_ 20_2016.pdf?la=en. Accessed
May 18, 2017.
3. Centers for Disease Control and Prevention.
Drug overdose death data. Available
statedeaths.html. Accessed May 18, 2017.
4. Rudd RA, Aleshire N, Zibbell JE, Gladden
RM. Increases in drug and opioid overdose
deaths—United States, 2000–2014. Morb
Mortal Wkly Rep. 2016; 64( 50):1378-1382.
5. Paulozzi LJ, Jones CM, Mack KA, Rudd RA.
Vital signs: Overdoses of prescription opioid
pain relievers–United States, 1999–2008.
Morb Mortal Wkly Rep. 2011; 60( 43):1487-1492.
6. 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.
7. 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-
8. Kaafarni HMA, Weil E, Wakeman S,
Ring D. The opioid epidemic and new
legislation in Massachusetts: Time for
a culture change in surgery? Ann Surg.
9. Liepert AE, Ackerman TL. 2016 state
legislative year in review and a look ahead.
Bull Am Coll Surg. 2016;101( 12): 35-39.
10. Jones T, Moore T, Levy JL et al. A
comparison of various risk screening
methods in predicting discharge from opioid
treatment. Clin J Pain. 2012; 28( 2):93-100.
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