“Our feeling is we shouldn’t just be using draconian, one-size-fits all prescribing,” said one expert from Johns Hopkins.
Surgeons at Johns Hopkins Hospital in Baltimore have developed opioid prescribing guidelines that are specific to 20 common surgeries, in an effort to reduce overprescribing.
“This work reflects that surgeons want to be a part of the solution,” Dr. Heidi Overton, a surgery resident at Johns Hopkins who worked on the guidelines, told The Baltimore Sun.
The guidelines were published this week in the Journal of the American College of Surgeons. Previously, Johns Hopkins doctors generally prescribed a 30-day supply of opioid painkillers following surgery, a standard that was “dangerously high,” according to lead study author Dr. Martin Makary, a professor of surgery and health policy expert at the Johns Hopkins University School of Medicine.
The new guidelines take into account what type of surgery a patient had. The panel that made the recommendations suggested one to 15 opioid pills for 11 of the 20 procedures, 16 to 20 pills for six of the 20 procedures, and none for three of the procedures—a drastic reduction from previous prescribing practices.
Patients having orthopedic surgeries needed the most opioid painkillers and those having ear, nose and throat procedures needed the fewest, study authors said. Doctors can adjust their prescription based on specific patients’ needs as well.
“Our feeling is we shouldn’t just be using draconian, one-size-fits all prescribing,” said Makary. “Everyone is different. Opioid prescribing should fall within a best practices range and currently we don’t do very well with that. Our hope is that this represents a first step in better understanding how we can treat pain better.”
Makary noted that one in 16 surgery patients become long-term drug users. He also explained that more than half of patients who did not need opioids to manage pain in the hospital are still sent home with a prescription. Because of that, 70 to 80% of opioids prescribed to patients are never used as prescribed.
Changing standards around opioid prescriptions is part of addressing the current overdose crisis, he said.
“We don’t just need treatment and rehab facilities,” Makary said. “We shouldn’t just be cleaning up the floor, but we should be turning off the spigot of overprescribing that doctors did with good intention, but bad science.”
Other teaching hospitals have tried to implement opioid prescription guidelines, but the American College of Surgeons has not addressed the issue.
However, the organization is putting together a brochure “to help surgeons facilitate a dialog with their patients on postoperative pain relief.”