Patients checking into a hospital for surgery is a very common occurrence. After their procedure, they want and expect to be given enough pain medication to be kept comfortable while they recover.
Often, the pain medication given by the surgeon and other medical providers is an opioid. They are prescribed for severe pain and are considered effective at providing temporary relief. The problem is that a number of doctors are prescribing these powerful painkillers without understanding how quickly patients can develop a dependency and thus start to experience withdrawal symptoms. When patients ask about how to taper off the medication when they are recovered from their surgery, they are often not getting enough information or accurate instructions.
Post-Surgical Opioid Dependency
Some doctors and hospital administrators are now asking the question, If some patients are becoming addicted to opioids starting with a stay in a hospital for surgery or another procedure, should the hospital be held responsible? Is the addiction a medical error in the same category as an infection acquired in hospital?
At least three physician/executives with the Hospital Corporation of America have argued that the answer should be, “Yes.” Drs. Michael Schlosser, Ravi Chari and Jonathan Perlin have stated that since this type of addiction arises during a hospital stay and is a “high-cost and high-volume condition,” and that it can often be avoided by implementing and applying new guidelines for patient care.
The doctors say that although it would be difficult for hospitals to monitor all the patients being given opioid pain medications in the weeks and months after their release, hospitals should have a system in place to try. The issue of long-term opioid use as a hospital-acquired condition opens the door for standards of care to be put in place to help patients manage their pain and protect them from coming to future harm.
Holding Hospitals Responsible May Have Financial Impact
Compensation and bonus structures at many hospitals are tied to patient satisfaction surveys, and that has been cited as one reason for doctors to continue over-prescribing drugs in an effort to keep patients happier. Less painkillers initially may mean that more patients experience some additional discomfort, and even though they may be saving lives from potential addiction, the doctors could wind up getting lower reviews and thus less pay.
Majority of Surgical Patients Have Drugs Left Over
Studies have revealed that the majority of patients (between 67-92 percent) have painkillers left over after surgery. Approximately 10 percent of patients need what is described as “intense pain management,” but it is difficult for physicians to identify which patients need this level of pain relief.
There are no set guidelines for what types of opioids should be prescribed after surgery, the typical dose that should be prescribe or how long patients should take them. In 2016, the Centers for Disease Control (CDC) released prescribing guidelines for opioids for chronic pain patients, but they only addressed acute pain briefly.
A new study published in September found that the optimal time for opioid use after surgery is between four and nine days.
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The medical community is immersed in the prescription painkiller epidemic in two ways. On the front end, doctors are often the ones prescribing the drugs like Oxycontin, Percocet and Vicodin to patients. Medical professionals are essentially the gatekeepers of prescription painkillers and often have to decide if patients are in legitimate need of medication or if they are seeking the painkillers to feed their addictions.
ER doctors are well aware that many people addicted to prescription drugs utilize the emergency department as a way to obtain narcotic painkillers. They often go into the hospital complaining of various aches and pains hoping that a doctor will write a prescription for drugs like oxycodone or hydrocodone. Generally, ER doctors see so many patients that drug seekers feel more comfortable trying to get prescriptions there, as they might slip through the cracks.
Some healthcare providers feel there are flaws in the drug monitoring systems that enable drug abusers to continue to score multiple prescriptions from multiple doctors without regulation. Imperfections in the current methods are being addressed before states can expect to fully rely on these monitoring systems to deter prescription drug abuse. Major adjustments in the system should allow doctors and pharmacists to utilize the program in the way developers intended.