As surgeons write for fewer opioids, there may be concern that we will see an increase in phone calls for refills or inadequate pain control. In fact, single institution studies found that with appropriate patient education, not only did patients consume less medication, but requests for refills did not increase.
To ensure appropriate pain management, all patients should receive counseling addressing the following items:
“Some pain is normal. You should be able to walk and do light activity, but may be sore for a few days. This will gradually get better.”
“Half of patients who have this procedure take under 10-15 pills.”
“Take acetaminophen and ibuprofen around the clock, and use the stronger pain pills only as needed for breakthrough pain.”
Avoid NSAIDs in patients with peptic ulcer disease and associated risk factors (smoking, drinking), bleeding disorders, renal disease, and specific operations at surgeon discretion.
“These pills are for pain from your surgery, and should not be used to treat pain from other conditions.”
“We are careful about opioids because they have been shown to be addictive, cause you harm, and even cause overdose if used incorrectly or abused.”
"Disposing of these pills prevents others, including children, from accidentally overdosing. You can take pills to an approved collector (including police stations), or mix pills with kitty litter in a bag and throw them in the trash.”
What are these recommendations?
These recommendations were developed by Michigan OPEN, based on patient-reported data from the Michigan Surgical Quality Collaborative and published studies. Recommended amounts meet or exceed self-reported use of 75% of patients. Previous studies have shown that when patients are prescribed fewer pills, they consume fewer pills with no changes in pain or satisfaction scores. Many patients use 0-5 pills. Recommendations are for patients with no preoperative opioid use. For patients taking opioids preoperatively, prescribers are encouraged to use their best judgment.
The recommendations will be updated frequently with new data. Sign up here to be notified when the recommendations are updated.
Michigan OPEN was founded to develop a preventative approach to the opioid epidemic in the state of Michigan through a focus on acute care prescribing. Addressing opioid prescribing during the acute care period among those patients not using opioids has the greatest potential to reduce the number of new chronic opioid users and minimize unintended distribution of prescription opioids into communities.
Michigan OPEN first published these opioid prescribing recommendations for surgery in the fall of 2017, along with educational materials for providers and patients. Visit michigan-open.org for more information.
Michigan OPEN compiles drug disposal information and resources for patients and providers. Click here for drug disposal information including an interactive map detailing opioid disposal sites within the state of Michigan.