Breaking News
October 16, 2018 - Researchers demonstrate integrated technique to control production of cell therapeutics
October 16, 2018 - Breast tomosynthesis detects 34% more tumors than traditional mammography
October 16, 2018 - Rhode Island Hospital, Brown receive $800,000 grant to keep up fight against opioid epidemic
October 16, 2018 - UVA partners with health systems in AVIA network’s Medicaid Transformation Project
October 16, 2018 - Trevena Announces Oliceridine FDA Advisory Committee Meeting Outcome
October 16, 2018 - Study reveals early warning signs of heart problems in patients with newly diagnosed lupus
October 16, 2018 - Connecting the dots of Alzheimer’s disease
October 16, 2018 - New publication offers evidence-based content for global breast imaging medical community
October 16, 2018 - ‘EinsteinVision’ that improves hand-eye coordination of surgeons introduced at Harefield Hospital
October 16, 2018 - WRAIR clinical study evaluates safety and immunogenicity of Marburg vaccine
October 16, 2018 - Ketamine can be considered as alternative to opioids for short-term pain control in ED
October 16, 2018 - Endurance exercise training beneficially alters gut microbiota composition
October 15, 2018 - FDA Approves Yutiq (fluocinolone acetonide intravitreal implant) for Chronic Non-Infectious Posterior Segment Uveitis
October 15, 2018 - Birthing Options for Full-Term Pregnancy
October 15, 2018 - Stressed, toxic, zombie cells seen for first time in Alzheimer’s
October 15, 2018 - Concussion researchers study head motion in high school football hits | News Center
October 15, 2018 - Neuropsychiatric symptoms related to earliest stages of Alzheimer’s brain pathology
October 15, 2018 - Neck collar device may help protect the brain of female high school soccer players
October 15, 2018 - Research reveals how the inner ear processes speech
October 15, 2018 - Many parents still skeptical about safety and effectiveness of flu shot, survey finds
October 15, 2018 - Payer Policies May Discourage Non-Pharma Tx for Low Back Pain
October 15, 2018 - Exercise may delay cognitive decline in people with rare Alzheimer’s disease
October 15, 2018 - Researchers modify CRISPR to reorganize genome | News Center
October 15, 2018 - Innovative brain tumor operation set to tailor to patients’ needs
October 15, 2018 - Findings offer new insight into early changes that occur during AD pathology
October 15, 2018 - Neurons regulating reproductive hormone release have different activity in epileptic mice
October 15, 2018 - More parents are concerned about taking babies swimming in public pools
October 15, 2018 - Health Tip: Know the Risk Factors for Lower Back Pain
October 15, 2018 - Study shows cigarillo flavors enhanced by high-intensity sweeteners
October 15, 2018 - Study traces hospital-acquired bloodstream infections to patients’ own bodies | News Center
October 15, 2018 - Abnormal vision in childhood can affect development of brain areas responsible for attention
October 15, 2018 - Study highlights need for increased support for alcohol-related liver disease patients
October 15, 2018 - Color-changing contact lens could help doctors to monitor eye disease medications
October 15, 2018 - Tobacco heating products cause less staining to teeth than conventional cigarettes
October 15, 2018 - Young adults who are obese can expect to lose up to 10 years in life expectancy
October 15, 2018 - Scientists uncover how proteins meet on the cell membrane
October 15, 2018 - Affordable housing with supportive social services for senior citizens can reduce hospital use
October 15, 2018 - Schiller Easy Pulse Saves Lives
October 15, 2018 - The latest ECG device from Schiller
October 15, 2018 - Following a Tissue Sample
October 15, 2018 - Prisoners need drug and alcohol treatments but AA programs aren’t the answer
October 15, 2018 - Andrea Califano and Jordan Orange Elected to National Academy of Medicine
October 15, 2018 - The impending risk of African Swine Fever Virus
October 15, 2018 - Breastfeeding reduces the number of antibiotic-resistant bacteria in infant gut
October 15, 2018 - Researchers develop comprehensive molecular atlas of postnatal mouse heart development
October 15, 2018 - ObsEva SA Presents Clinical Data from Phase III IMPLANT 2 Trial of Nolasiban in IVF at the American Society of Reproductive Medicine (ASRM) Annual Meeting
October 15, 2018 - Engineering teratoma-derived fibroblasts to enhance osteogenesis
October 15, 2018 - Lab study shows effectiveness of potential therapy for treatment-resistant hypothyroidism
October 15, 2018 - JCU study firms up association between diet and depression
October 15, 2018 - Researchers to study the use of CRISPR on human liver on-a-chip platform
October 15, 2018 - Sub-concussive impacts not associated with decline in neurocognitive function
October 15, 2018 - Researchers find potential treatment to halt premature labor and birth
October 15, 2018 - As U.S. suicides rates rise, Hispanics show relative immunity
October 15, 2018 - FDA Issues a Complete Response Letter to Acacia Pharma for Barhemsys
October 15, 2018 - Photoactive bacteria bait may help in fight against MRSA infections
October 15, 2018 - Increasing vigorous exercise reduces risk factors of type 2 diabetes, cardiovascular disease in children
October 15, 2018 - First-of-its-kind study to test a personalized vaccine in cancer patient
October 15, 2018 - Extension trial assesses benefit of switching from flash monitoring to RT-CGM for hypoglycemia
October 15, 2018 - Half of parents say young children are afraid of doctor’s visits
October 15, 2018 - Study shows how fingerprint-based drug screening works on the living and deceased
October 15, 2018 - Study reveals potential to monitor progression of Alzheimer’s disease by measuring brain antioxidant levels
October 15, 2018 - FDA Approves Xarelto to Reduce the Risk of Major Cardiovascular Events in Patients with Chronic Coronary Artery Disease (CAD) or Peripheral Artery Disease (PAD)
October 15, 2018 - Promising new therapeutic approach against Ebola virus identified
October 15, 2018 - Study unravels how cancer stem cells use normal genes in abnormal ways
October 15, 2018 - Healthcare systems fail to deliver at affordable prices finds report
October 15, 2018 - Intensive BP Therapy in Diabetes May Lower Risk for CV Events
October 15, 2018 - Muscle relaxants increase risk of respiratory complications
October 15, 2018 - Female birds become more promiscuous after hatchings fail in the first breeding attempt
October 15, 2018 - Humans occupied Madagascar thousands of years later than previously thought
October 15, 2018 - Is Kidney Dialysis Always Needed When Septic Shock Strikes?
October 15, 2018 - Study shows invasive lung cancer surgery can lead to long-term opioid use
October 15, 2018 - Sugar, a “sweet” tool to understand brain injuries
October 14, 2018 - King’s commemorates activities and research on World Arthritis Day
October 14, 2018 - Humana and VFW NY team up on Stop 22 initiative to increase awareness of veterans committing suicide
October 14, 2018 - Water fluoridation contributes to urinary fluoride levels in pregnant women in Canada
October 14, 2018 - Study of children in Romanian orphanages tells cautionary tale about family separation
October 14, 2018 - Previous Endologix AFX Safety Notice classified by FDA as Class I recall
October 14, 2018 - Legal scholars sound alarm on academies’ report about returning research results to participants
October 14, 2018 - UNIST selects six extraordinary scholars to be induced as ‘Rising-star Distinguished Professor’
October 14, 2018 - Scientists find new way to help asthmatics breathe more easily
Stopping opioid addiction at one key source: The hospital

Stopping opioid addiction at one key source: The hospital

image_pdfDownload PDFimage_print

Their findings appeared online Wednesday in the journal JAMA Surgery.

Opioid addiction has been deemed a “national emergency.” It’s estimated to have claimed 64,000 lives in 2016 alone. And research shows that post-surgical patients are at an increased risk of addiction because of the medication they receive to help manage pain during recovery.

It’s a simple enough idea: Surgeons should give patients fewer pills after surgery — the time when many people are first introduced to what can be highly addictive painkillers. They should also talk to patients about the proper use of opioids and the associated risks.

That seemingly small intervention could lead to significant changes in how opioids are prescribed and make inroads against the current epidemic, said the researchers.

“The way we’ve been prescribing opioids until this point is we’ve basically been taking a guess at how much patients would need,” said Jay Lee, a research fellow and general surgery resident at the University of Michigan, and one of the paper’s authors. “We’re trying to prevent addiction and misuse by making sure patients themselves who are receiving opioids know how to use them more safely — that they are getting a more consistent amount and one that will reduce the risk of them getting addicted.”

The researchers identified 170 patients who underwent gallbladder surgery and surveyed them within a year of the operation — asking how many pills they actually used, what pain they experienced after surgery and whether they had used other painkillers, such as ibuprofen.

They used those findings to create new hospital guidelines that cut back the standard opioid prescription for gallbladder surgeries.

Then, they analyzed how patients fared under the new guidelines, tracking 200 new surgery patients who received substantially fewer pills — an average of 75 milligrams, compared with 250 mg previously. Despite getting less medication, patients didn’t report higher levels of pain, and they were no more likely than the previously studied patients to ask for prescription refills. They were also likely to actually use fewer pills.

The takeaway: After surgery, patients are getting prescribed more opioids than necessary and doctors can reduce the amount without experiencing negative side effects.

Within five months of the new guidelines taking effect at Michigan Medicine, surgeons reduced the volume of prescribed opioids by about 7,000 pills. It’s now been a year since the change took effect, and the researchers estimate they have curbed prescriptions by about 15,000 pills, said Ryan Howard, a general surgery resident and the paper’s lead author.

That has real implications. Studies have found that overprescribing opioids helps drive the epidemic. It can put patients at risk of addiction. And it endangers friends and family, who can easily acquire unused excess pills in, for instance, an unsecured medication cabinet. Reducing prescriptions altogether makes that less likely.

“This really shows in a very methodological way that we are dramatically overprescribing,” said Michael Botticelli, who spearheaded drug-control policy under the Obama White House, including the administration’s response to the opioid crisis.

“Not only do we have to reduce the supply to prevent future addiction, but we really have to minimize opportunities for diversion and misuse,” he said.

More hospitals are starting to turn in this direction, Botticelli said. He now runs the Grayken Center for Addiction at Boston Medical Center, which is also trying to systematically reduce opioid prescriptions after patients have surgery.

Meanwhile, 24 states have passed laws to limit how many pills a doctor can prescribe at once, according to the National Conference of State Legislatures.

“Those limits are just sort of generic limits across the board,” said Chad Brummett, an anesthesiology professor at the University of Michigan and another co-author of the paper. Their concept, he added, “is a step even further beyond what some of these policymakers are trying to do, and it’s one I think surgeons are more likely to adopt.”

The researchers also created a set of talking points for doctors and nurses to use with patients based on “fairly common sense” measures, Lee said. They include:

  • Encouraging patients to use lower-strength, non-addictive painkillers first;
  • Warning them about the risks of addiction; and
  • Reminding them that even a sufficient opioid prescription would leave them feeling some pain.

The talking points also offer tips for patients on safely storing and disposing of extra pills.

“So much of this problem can be addressed with solutions that are not complicated … like telling patients what to do with the medications when they’re finished using them,” said Julie Gaither, an instructor at Yale School of Medicine. Gaither has researched the opioid epidemic’s consequences, though she was not involved with this study.

The Michigan team is pushing its new prescribing guidelines online, in hopes of encouraging other hospitals to adopt similar practices. It also has started implementing the change in other hospitals around the state.

Still, this gets at only a small part of the problem, noted Jonathan Chen, an assistant professor of medicine at Stanford University, who has also researched opioid abuse and addiction. The bulk of opioid prescriptions are written by family doctors and general internists, he said.

“This won’t solve every problem — but nothing ever does,” said Chen, who was not involved with this study. “It’s one concrete area, and a natural place to start.”


Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Tagged with:

About author

Related Articles