The statistics on the ravages of opioid addictions and overdoses in the United States and elsewhere paint a dreadful, tragic picture. In 2016, more than 60,000 people died from opioid-associated overdoses in the U.S., and that number increased by an incredible 20% in 2017. Many of these addictions begin with prescription narcotics, making the risk of long-term addiction from medications prescribed in a health care setting painfully clear. A recent study by the Centers for Disease Control and Prevention (CDC) showed a 6% risk of long-term opioid use after a prescription for as little as one day of opioids. That risk starts to increase after three days, doubles after seven days, and quadruples after 30 days.
As physicians tasked with ensuring the safety and health of our patients, we are obligated to take this epidemic seriously and to ensure our patients are not exposed to unnecessary risks to their health.
To this end, several groups of physicians, pharmacists and others within BayCare have been studying our collective use of narcotics and ways in which we might institute common-sense guidelines for their use. Some of these guidelines have been presented to our Medical Staff Advisory Council and will soon be forwarded to each medical staff’s Medical Executive Committee.
These guidelines are aimed primarily at the use of narcotics in opioid-naïve patients. They encourage physicians to limit narcotic use for minor surgeries and injuries to three days of therapy, and for major surgeries to seven days, reflecting the findings of the CDC’s study on the risk of long-term use.
Of course, patients have legitimate need for pain relief during the healing process, obligating us to find ways to treat patients’ pain in ways that don’t involve narcotics. There are a multitude of options here, from over-the-counter pain relievers such as NSAIDs and Tylenol, to long-acting nerve blocks to non-medical therapy such as ice, music, appliances, etc. It is also important to educate patients on the risks associated with narcotic use, and to engage them as partners in keeping them as safe – and as comfortable – as possible.
Efforts are also underway throughout BayCare to address patients who have become dependent on narcotics. Our emergency departments no longer refill narcotic prescriptions and are very conservative in initiating narcotic therapy for patients presenting with injuries and medical conditions. The Behavioral Health Department, under the leadership of Dr. Nick Dewan, has developed a program to help patients dependent on narcotics overcome their addiction in a safe and effective manner. Under the leadership of Mike Magee, another group is looking at more safe and efficient ways to use narcotics within our various facilities.
In summary, the epidemic of narcotic-associated overdose deaths, and the accompanying scourge of narcotic addictions, present an opportunity for us as physicians to protect our patients and do our utmost to ensure their optimal health and welfare, which is what physicians have always done. We encourage and invite each of you to work with your physician leaders to adopt and implement these emerging BayCare guidelines.