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post-surgical painkiller addiction

Should Hospitals be Accountable for Post-Surgical Painkiller Addiction?

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.

How Hospitals Can Help Reduce Opioid Misuse

doctor in hospitalGiven the nature of hospitals and the amount of pain surrounding accidents, injuries, illnesses and surgeries, there is often an abundance of prescription drugs floating around. However, with the spotlight on reducing the impact of painkiller abuse on society, more hospitals are facing increased scrutiny about the way they handle and distribute opioids.

Two executives from Comprehensive Pharmacy Services recently issued an article outlining several steps that hospitals can take to help protect themselves and their patients from prescription drug misuse and abuse. They targeted six areas to address regarding this problem.

1. Review policies and procedures that are in place to minimize diversion.

2. Create standards for ordering and prescribing controlled substances.

3. Establish education and training across multiple disciplines to educate staff on controlled substance diversion.

4. Place camera surveillance in high-risk areas.

5. When something does go wrong, have procedures ready to launch to investigate potential cases of diversion and discrepancies in controlled substance inventory.

6. Review staff practices that can help avoid the problem on the front end by reducing the vast number of opioid prescriptions that are being written.

In recent years, many hospitals have taken measures to limit the number of pain pills being handed out through the ER. Emergency rooms have long been a source for drug seekers to get narcotics from through minor injuries or faking pain symptoms. Now they have cut back both in the number of overall prescriptions in most cases, but also have limited the number of pills being given per script.

If more physicians and hospitals continue to be aware of the trouble spots surrounding the prescribing of opioids and implement policies to correct them, they should be able to keep more of these drugs out of the wrong hands.