The Opioid Crisis in America

My practice is committed to reducing the likelihood of prescription pain medicine dependence, which has been shown to lead to addiction and the epidemic of heroin use and fatalities in this country. I am committed to helping my patients have a successful post-operative course and avoid issues with narcotic pain medicine and abuse.

The first line drugs for post-operative pain are the non-steroidal anti-inflammatory such as acetaminophen, naproxen (Motrin, Advil, Aleve, etc.)  agents. Over the counter medicines work well in many cases. Stronger prescription versions are also available.  For "break-through" pain in the immediate post-operative period, limited use of opioids / narcotics is appropriate and relatively safe.

If narcotic medication use persists beyond this period I will refer my patients to a Pain Medicine Specialist Physician to manage dosing, tapering and appropriate alternative therapies.

The Center for Disease Control and Prevention (CDC) reports that from 1996 to 2006 the sales of prescription opioids in the United States quadrupled additionally with the rates of overdose, death, and substance abuse treatment admissions spiraled.[1] In 2013, almost two million Americans, 12 years or older, either abused prescription opioids or became hooked on them. In the same year more than 16,000 people in the United States died of an overdose related to opioid pain relievers. [2]

More opioids are used in the United States than any other country.  The US consumes virtually all of the hydrocodone and 81% of the oxycodone in the world. [3] Comparing the United States and The Netherlands, one study found that the 85% of patients in the United States were prescribed opioids after discharge compared to none with Dutch patients. [4]

I am actively working to reduce opioid use and abuse in our specialty societies and I am instituting policies in my own practice to help lead the way.  

References:

1. Centers for Disease Control and Prevention (CDC).  Vital signs: overdoses of prescription opioid pain relievers – United States, 1999-2008.  MMWR Morb Mortal Wkly Rep. 2011;60:1487-1492.
2.  Centers for Disease Control and Prevention (CDC).  National Vital Statistics System.  Mortality data.  February 16, 2016. http://www.cdc.gov/nchs/deaths.htm  Accessed April 18, 2016.
3. Volkow ND. American’s addiction to opioids: heroin and prescription drug abuse.  National Institute on Drug Abuse.  May 14, 2014. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. Accessed April 18, 2016.
4. Lindenhovius AL, Helmerhorst GT, Schnellen AC, Vrahas M, Ring D, Kloen P.  Differences in prescription of narcotic pain medication after operative treatment of hip and ankle fractures in the United States and The Netherlands.  J Trauma. 2009;67:160-164.