Debra Gordon, co-director of the Harborview Integrated Pain Care Program at the University of Washington in Seattle, called for the creation of databases or registries to collect information on individual surgical patients and pain management.
“There’s no cookbook here,” she said in a phone interview. “You want to customize so that we give the most effective and the safest pain control for everybody.”
Gordon, a clinical nurse specialist who was not involved in the new research, believes some patients may intentionally squirrel away opioid painkillers to save for unforeseen emergencies.
Also, she said, “The system is set up to facilitate the problem. A doctor doesn’t want to be called two, maybe three, days after their patient goes home” to write a second prescription for more painkillers.
Insurance reimbursement for prescription drugs could also exacerbate oversupply. Some insurance companies limit patients to one prescription a month, regardless of the number of pills in the bottle, she said.
Gordon and Bicket both stressed the need to balance concerns about the misuse of opioids against the need to adequately treat post-surgical pain.
“The big faceoff comes between making sure we don’t undertreat pain after surgery and we don’t overprescribe and have the injuries and deaths that come as a result of the opioid crisis,” Bicket said.
“I’m a little concerned that we don’t move the pendulum too far in the other direction and undertreat people,” Gordon said. “Opioids are very dirty, nasty drugs, but they do have a role.”
Reference
Bicket MC, Long JJ, Pronovost PJ, et al. Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review. JAMA Surgery. 2017 Aug 2.
