This week even the White House took notice of the opioid epidemic, declaring opioid abuse a national public health emergency. However, the opioid epidemic was recognized as early as the 1990s, when doctors became increasingly aware of the burdens of pain.
But, saying there is a problem – the opioid epidemic which has long been recognized – and doing something about it, are two completely different things.
To help do something about it, we offer 7 must reads for beating the opioid epidemic:
#1 Must Read – Using continuous patient monitoring provides an early detection of respiratory compromise
In a clinical education podcast released by the Physician-Physician Alliance for Health Safety, Jeffrey S. Vender, MD. cautions that otherwise stable patients can quickly move down the dangerous path to respiratory compromise:
“There are numerous situations where patients with underlying pulmonary disease are in very chronic, but stable conditions. And, for a multitude of reasons, either a therapeutic intervention, the administration of pharmaceutical agents, in particular sedative agents and/or narcotics, as you’ve alluded to, or an underlying disease, like pneumonia, can make this stable respiratory condition and move it down the spectrum of patho-physiologic deterioration into respiratory compromise.”
Dr. Vender believes that “there’s been a lack of understanding of how to monitor better, or to recognize better, those patients at-risk.” He encourages clinicians to do “a better job of monitoring and understanding the drugs we use in those patients at risk, so we can reduce these complications.”
#2 Must Read – Use a Multi-Modal Approach to Pain Treatment
Using a multi-modal approach to pain treatment has been credited with contributing to a one third decrease in the opioids used after hip and knee replacement surgeries from 2006 to 2014, according to researchers at the University of Massachusetts Medical School.
#3 Must Read – Don’t prescribe gabapentin with opioids
Researchers at the University of Toronto have found that concomitant “use of gabapentin and opioid analgesics significantly elevates the risk of opioid-related death.” They calculate that the risk increases by 49%.
#4 Must Read – Make sure sedation practices meet current standards
The idea that sedation in one area (for example, in the operating room) is somehow different when done in another (such as during a dental procedure) is simply baffling, write Annie Kaplan, MD, Michael Wong, JD, and Patricia Salber, MD, MBA. They believe that the standards during dental anesthesia should be the same as for any other type of procedure.
#5 Must Read – Develop an opioid prescription risk management plan
Diane Doherty writes that “To protect their revenue stream and reduce their liability exposure while simultaneously delivering on the single most important goal—patient care—hospitals and healthcare providers must develop comprehensive risk management strategies to address the misuse and abuse of opioids. The following interventions are recommended to help safeguard prescribing practices and help minimize patient harm and associated liabilities.”
#6 Must Read – Put into practice recent multisociety postoperative pain guidelines
Many medical societies and organizations have recently released guidelines on postoperative pain management, use this handy table as a reference to these guidelines.
#7 Must Read – Take a more balanced approach
Though much of the attention on opioid-related harm is centered on the improper use of opioids in the community (misuse, diversion, etc), the truth is that opioid harm exists across a continuum of care. The safe use of opioids begins with the safe use of opioid analgesics in the hospital setting and the prescription of opioids upon discharge of the patient from a healthcare facility. We must first and foremost make sure that opioids provided to patients are done so in a safe manner both during administration and upon discharge.
Use these 5 steps for a more balanced approach.