Following the introduction of new prescribing guidelines, surgeons at Dartmouth-Hitchcock are reducing the number of opioids they give patients after undergoing certain minor procedures.
Doctors say the initiative is an important step in reducing the number of painkillers available as the state reels from an ongoing opioid epidemic.
Results published this week in the journal Annals of Surgery found a 53% reduction in the number of pills prescribed for five common outpatient procedures at Dartmouth since introducing the new guidelines, with the pain needs of patients still being met.
“What we showed is that just by educating docs about how many opioid pills the patients really need, we were able to decrease the number of pills that were prescribed,” says Richard Barth, a surgical oncologist at Dartmouth-Hitchcock.
To implement the program, doctors at Dartmouth surveyed former patients, asking how many of the opioid pills prescribed after procedures including hernia repairs and gallbladder operations they actually used. After learning that patients took just 28% of the prescribed pills, the hospital decided to issue new guidelines with far lower pill amounts.
Doctors also recommended that patients use over-the-counter drugs including ibuprofen and acetaminophen to deal with pain during recovery, with opioids as a secondary option.
“So you set an expectation in a patient’s mind that they are not going to need opioids, and that the Tylenol and ibuprofen are going to be good enough to take care of the their pain,” says Barth. “And the bottom line is most of the time it did work out just fine.”
Other research studies document how oversupply of potentially addictive opioids can lead to diversion--that is, drugs end up in the hands of people other than the patient, resulting in misuse and potential overdose.
“If we cut down the number of opioids that are prescribed, we’ll have a big impact on the number of deaths down the road,” says Barth.
With these promising results, Dartmouth-Hitchcock plans to expand the use of new opioid guidelines to other departments, including more serious in-patient surgeries.