The Opioid Crisis: Patient Safety and Education

This national public health emergency affects millions of Americans. The amount of opioids prescribed tripled between 1999 and 2015, and it’s now recognized that these medications, though quite effective for some types of pain, pose serious risks. Along with dependence and addiction, users may also experience a lesser-known adverse effect that can actually increase the amount of pain they feel (a condition called opioid-induced hyperalgesia).

The consequences have been devastating. In 2016 more than 11 million people reported misusing prescribed opioids like hydrocodone, oxycodone and codeine, many of them by taking a friend’s or relative’s pills to relieve pain. Heroin and now fentanyl use has soared in recent years as opioid overprescribing was reduced. More than 2 million people have developed an opioid use disorder with 115 people dying every day from an overdose.

What do you need to know about opioids and surgery?

At HSS, our clinicians are committed to managing postsurgical and chronic pain safely and effectively, while working with patients to minimize the risks of opioid use. When it comes to surgery and opioids:

• our surgeons and anesthesiologists are experts in employing a variety of pain-management treatments, including multimodal approaches that combine non-opioid pain medications with therapies such as nerve blocks given by injection or catheter.
• when possible, our clinicians seek to reduce or eliminate patients’ exposure to opioid pain medications before and after surgery.
• as a surgical patient at HSS you receive a preoperative screening, in which your clinical team determines the best pain-management approach for your recovery.

Visit our guide on Opioids and Your Recovery for more details on opioid prescribing, risks, and disposing of unused opioid pills. More educational resources including articles, blogs and videos are featured below.

Opioid Safety and Education Articles

• The Importance of Preoperative Pain Screening for Surgical Patients
  Learn why preoperative pain screening evaluation is important to ensure successful surgical outcomes, from Medical Director, Faye Rim, MD.
• Multimodal Analgesia: Move Better, Quicker After Surgery with Fewer Side Effects
  Learn how multimodal analgesia improves patient outcomes and reduces the need for opioid therapy, from HSS anesthesiologist, Kanupriya Kumar, MD.
• Opioid-Induced Hyperalgesia
  An article describing a serious, but relatively unknown side effect of long-term opioid use, from Director of Medical Pain Management, Vinnidhy Dave, DO.
• A Patient’s Guide to Opioid Tapering
  Learn how doctors help patients safely reduce opioid use, from Director of Medical Pain Management, Vinnidhy Dave, DO.
• Opioids: Understanding Addiction Versus Dependence
  Learn the differences between addiction and dependence, two serious side effects of opioid use, from Clinical Social Worker, Justin Donofrio.
• Identifying and Treating Chronic Pain
  HSS Anesthesiologist, Joseph Hung, MD explains how multimodal pain management techniques, rather than opioid treatments, are recommended for chronic pain.
• Regional Anesthesia and Pain Management Innovations Improve Patient Outcomes
  This article includes a discussion with Anesthesiologist-in-Chief, Gregory Liguori, MD on how to reduce the need for postsurgical opioid use.

Support Group Summaries

• Coping With Pain Caused by a Chronic Disease
  This article includes a brief discussion on why opioids are not advised to treat the chronic pain associated with rheumatic diseases like rheumatoid arthritis.
• The Complex Problem of Pain
  This article includes a brief discussion on the benefits, risks and side effects of opioids.
• Speaking of Pain: How to Help Your Doctor Help You
  This article on the chronic pain associated with rheumatoid arthritis (RA) includes a brief discussion on why opioids are not advised and provides information on alternative pain medications for RA.

Opioid and Chronic Pain: Special Publications

Posts from the HSS Blog: The Playbook

• Could IV Acetaminophen Reduce the Need for Opioid Medication After Hip Replacement?
  HSS orthopedic surgeon Geoffrey Westrich, MD, highlights this HSS pain control clinical study.
• Ask the Expert: Post-Laminectomy Syndrome
  Seth Waldman, MD, Director of the Division of Pain Management at HSS, discusses reducing opioid use as much as possible after spinal surgery to avoid opioid-induced hyperalgesia, addiction and other side effects.
• How Do You Dispose of Expired Medication?
  Learn the proper way to dispose of opioids and other prescription medications from Seth Waldman, MD, Director of Pain Management at HSS.
• A Parent’s Guide to Opioid Safety
  HSS anesthesiologist Kate DelPizzo, MD, discusses safe medication disbursement and storage for parents of children who are prescribed opioids.
• Paved With Good Intentions
  Seth Waldman, MD, Director of the Division of Pain Management at HSS, gives a brief overview of the rise of the current opioid epidemic and appropriate responses by the medical community.
• The Role of Safe Opioid Prescribing in Orthopedic Surgery: What You Need to Know
  HSS anesthesiologist Kanupriya Kumar, MD, discusses current medical practices that aim to reduce the use of opioids for postsurgical pain management.
• Sports Injuries in Young Athletes: How to Manage Pain Post-Surgery
  Pediatric sports physician and orthopedic surgeon Peter Fabricant, MD, includes a discussion on opioid treatment options and precautions for children and adolescents.
• Ask the Expert: Questions on Managing Post-Operative Pain
  HSS anesthesiologist Philip Wagner, MD, provides some opioid guidance and information in answer to patient questions on postsurgical pain management.

Health Video Library

Complementary Alternatives in Pain Management (20 mins)
Nancy O’Brien, C-IAYT

Exercises and Mind Body Approaches for Avoiding Pain (11mins)
Giusi Gerbino, PT, DPT

Facebook Live Videos