Doctors in Ohio have been working on a new approach to patient care and pain management to reduce opioid usage. Could this be a much-needed solution for the ongoing crisis? Jean West investigates.
Written by Jean West | Photo by Kylene White
For decades, doctors have prescribed opioids as the primary method of pain management for patients after surgery. While opioids are highly effective, they come with side effects that can slow recovery and present a risk for misuse or addiction. With an ongoing nationwide opioid epidemic, medical professionals at Ohio State University have implemented an opioid-sparing surgical recovery protocol for cancer patients that has shown to shorten recovery times and improve patient outcomes.
Since its start in 2016, experts have documented a 25% reduction in average post-surgical hospital stay and a 50% reduction in use of opioid-based pain medications during and immediately after surgery. Considering opioids usage has become a crisis in this country leading to addiction, trafficking and overdose deaths, these results are impressive.
“Opioids can cause nausea, breathing issues and can cause the GI tract to not wake up as fast after surgery,” says Dr. Michelle Humeidan, the anesthesiologist who leads the enhanced surgical recovery and pain management initiative at Ohio State. “Less opiates means less side effects and faster recovery. Patients are able to go home from the hospital sooner and continue to do as well if not better than they would have with the old style of pain management.”
The opioid-sparing protocol uses a regiment of drugs such as acetaminophen before surgery, regional or nerve blockers during surgery and over-the-counter pain medication after surgery. It also incorporates less bed rest and more movement for patients after surgery.
“We have greatly expanded implementation of opioid-sparing surgical recovery programs in the course of about seven years,” Dr. Humeidan says. “That’s great because patients can continue their recovery at home and feel empowered to take care of themselves. This also enables them to feel that their concerns are being heard and that the healthcare system is providing options to manage their pain in a way they are comfortable with.”
The movement to lessen the use of opioids for pain relief using less addictive drugs should reduce the rates of addiction and save lives. In 2009, the rate of drug-induced deaths in Kentucky significantly exceeded the national average. For the 2004- 2008 time period, three Kentucky counties ranked in the top ten for rates of drug poisoning deaths in the nation. These counties include Bell County at 47.9 deaths per 100,000 population (the 6th highest), Clinton County at 46.8 deaths per 100,000 population (the 7th highest), and Martin County at 44.5 deaths per 100,000 population (the 10th highest).
According to the Centers for Disease Control, 38% of Kentucky residents report having a family member or friend who struggles with prescription drug addiction. In 2019, drug abuse caused 52,294 emergency room visits in Kentucky alone. Per the CDC, Kentucky has the 5th highest opioid dispensing rate in the US (68.2 per 100 people). Compared to other states, Kentucky had the 7th highest number of overdose deaths in 2019 when adjusted for population. Fentanyl, a synthetic opioid that is stronger than both heroin and morphine, causes more overdose fatalities than any other type of drug. In Kentucky, fentanyl was present in 70% of overdose deaths in 2021.
“The drug epidemic is not a Kentucky issue or political issue, but a nationwide issue that is affecting everyone and every state,” Van Ingram, executive director of the state Office of Drug Control Policy, shared in a news release. “Our focus over this next year will be on increasing access to clinical care for those suffering from an addiction and offering more harm reduction measures.”
Kentucky recorded 2,250 overdose deaths in 2021. That was 286 more OD deaths than the 1,964 reported in 2020, when the increase from the previous year was 54%.
In spite of the dangers for misuse and addiction, opioids are still needed for the management of acute and chronic pain from conditions like cancer, back ailments and other serious injuries. But it must be under the supervision of physicians or pain management specialists.
Having just had recent surgery (see my column in the December 2022 issue), I am thankful it exists, but my medication was prescribed by my surgeon, with strict instructions for its use and with a limited number of pills. It’s certainly helped me to heal.
Experts hope the success of the opioid-sparing approach at Ohio State will prompt more healthcare institutions to explore similar surgical recovery protocols, making a major impact on the number of patients exposed to addictive medications and hopefully make an impact on the opioid crisis.
Read Jean West’s Modern Family column “Un Happy Feet“.