Findings from Hospital for Special Surgery (HSS) in New York and Midwest Orthopaedics at Rush in Chicago offer strong evidence that, “Qualitative guidelines and prescriber education are effective in reducing the amount of opioids prescribed at discharge and encouraging the use of weaker opioids. Coupling provider education with prescribing guidelines is likely synergistic in achieving larger reductions.”
The study, “An institutional intervention to modify opioid prescribing practices after lumbar spine surgery,” was published in the February 5, 2019 edition of the Journal of Neurosurgery.
Co-author Todd Albert, M.D., surgeon-in-chief, medical director and the Korein-Wilson Professor of Orthopaedic Surgery at HSS, described the context for the study to OTW, “Given the opioid crisis and pendulum swinging from pain being the 5th vital sign to physicians massively overprescribing, we at HSS wanted to be leaders in opioid education and appropriate use/prescribing methodology. We started with education—our program had 100% compliance across the institution. Then we studied the before and after prescribing behavior with education and then with guidelines.”
As part of the study, HSS required its staff to attend an educational conference regarding opioid use. Then the HSS used a consensus method among the spine service members to publish qualitative prescribing guidelines.
Specifically, the study authors looked at data for 2,479 patients who had undergone lumbar spine surgery and compared those results based on the timing of surgery.
They divided the study group into two groups–a preintervention group of 1,177 patients who had undergone spine surgery in the period before prescriber education and guidelines (March 1, 2016–November 1, 2016) and then a postintervention group 1,302 patients who had undergone spine surgery after the dissemination of the guidelines (February 1, 2017–October 1, 2017).
The investigators classified the surgeries as either decompression or fusion procedures. Patients who had undergone surgeries for infection and patients on long-acting opioids were excluded.
Dr. Albert summarized the lessons from the study this way” “Education and the institution of agreed-upon service specific guidelines works. This leads to many less wasted narcotics, cost saving and less pills being available for misuse. This is doable and to the extent possible all should institute it at their institutions.”
Why can you buy opioid ‘over-the-counter’ medication in South Africa – it’s been readily available even during apartheid, no problems – for instance ‘mybulin’/stopayne/myprodol – but we’ve never had an ‘opioid-epidemic’? Seriously, this is bloody ridiculous, that many of us spinal injury patients can’t even damn access pain meds, but because of probably initially a ‘hand-full’ of people misusing opioids in the USA, and then it been somehow manufactured and shipped in from China we all have to suffer! We are damned patients suffering in pain! (FYI – in SA we learnt decades ago to add a little caffeine into our opioid products, and so no one is dumb enough to try & inject it! So that people who need them – can get them!)
thank you or your ever so true statements…those of us suffering can’t get a vicodan if our life depended on it..CRUEL to spine and pain patients!!