What Are Your Thoughts on the Opioid Epidemic and What Surgeons Can Do to Help?

Q: What are your thoughts on the opioid epidemic and what surgeons can do to help?

A: The opioid epidemic is truly a massive crisis in our country. Approximately 60,000 people die every year from opioid-related events.

Compare this to the Vietnam War memorial, an emotionally impactful memorial which lists the 58,000 names of service men and women who died over the 15-year period of the Vietnam War. Opioids are doing this to our country every year. In Ohio, it’s a particular problem, so this is one crisis that is very close to home.

So what can we do as surgeons? I think there are many things we can do. First, I think by optimally using minimally invasive surgical approaches and optimizing perioperative care with multimodal analgesia, appropriate nerve blocks and careful attention to technique, we can get many patients home after major abdominal surgery taking minimal or no opioids. This is a frequent event for us now. We have up to 30 percent of patients going home the day after minimally invasive bowel resection and many of them take no opioids.

Even with these advances, many patients still need opioids. It behooves us to not automatically give prescriptions for 60 or 80 strong opioid pills. There are good data that many of these pills lay unused and that up to 1 in 16 patients prescribed opioids after surgery become addicted. We should prescribe smaller prescriptions, less frequently, and give smaller refills when necessary.

This takes effort. We have to tell our patients that pain is normal after surgery. The goal of medications is to make the pain bearable, not to remove all pain.

In addition, there is now some interesting research that explores personalized medicine for patients having major surgery. In a paper that we published in the American Journal of Surgery in March of this year, we explored the use of pharmacogenetics to optimize analgesic choices for patients undergoing surgery. Somewhat to our surprise, as we already have a highly evolved enhanced recovery protocol, we had to change the analgesics we chose in 50 percent of our patients. Patients often overmetabolize or undermetabolize certain agents, leading to us giving higher doses of an opioid that won’t work or increasing the chance of patients having complications from medications.

So whether it’s by combining technology, new standards of care or simply controlling the amount of opioids that we prescribe, this is something that is crucially important for our patients ― and a must as we try and improve the overall health of the populations we serve.

Conor Delaney, MD, PhD
Chairman, Digestive Disease & Surgery Institute
Cleveland Clinic

Follow Dr. Delaney on Twitter @ConorDelaneyMD