Surgery And Opioids: Developing Best Practices For Post-Addiction Care

March 26, 2018
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The ongoing opioid crisis has presented countless challenges to doctors and hospital administrators, but one of the most overlooked issues – and one with potentially life-altering results – is how we treat pain in recovering addicts.

People in recovery suffer serious illnesses and require surgery just like everyone else, but giving them opioids can derail their recovery. Hospitals with established pain management protocols for post-addiction care, though, have the ability to provide informed, sensitive care that can relieve patients’ pain without compromising their recovery.

Ask the Right Questions

Statistically speaking, very few surgical patients misuse opioids, particularly when they’re given short-term and under supervision; studies have found only about 0.2% of surgical patients develop an opioid addiction as a direct result of their post-surgical prescription. For former addicts, though, prescribing opioids can set off a cascade of consequences. That’s why the first step to providing addiction informed care is asking the right questions.

When taking a medical history, providers typically ask about current drug use, but it’s important to ask more directly about addiction. That includes asking about prior treatment and what substances the individual has used in the past. For example, someone with a history of using alcohol or stimulants can safely use opioids for pain relief, but patients who have used heroin in the past should be given alternative treatments. You need the whole picture to provide the right mode of pain relief.

Build A Treatment Team

Surgeons rarely operate alone; they’re part of a larger team with primary care physicians, anesthesiologists, and other specialists. Why not pair them with addiction specialists as well? The addiction treatment experts at Resurgence Behavioral Health recommend pairing surgeons with addiction medicine specialists to gain insight into a given patient’s psychological and physical pain management needs.

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Working with an informed team saves lives. Just ask the family of Maxwell Baker, a 23-year-old man who died of a Vicodin overdose in 2016, after a car accident sent him into surgery. Max was in recovery from prescription drug and heroin abuse, had received suboxone for treatment, and been weaned off that medication as well. Just as he planned to return to work and school, though, Max was in a car accident. He informed his surgeon and anesthesiologist that he had suffered from opioid addiction but they felt uncomfortable treating him differently because of his previous addiction issues. They didn’t consult any addiction specialists.

The use of opioids to treat his pain while inpatient sent Max into a tailspin and within a month he died of a heroin overdose. The team needed more input from addiction specialists and greater awareness of the patient’s history. Surgeons and anesthesiologists may understand the basic terms of addiction, but their fear of stigma, concerns about pain, and lack of knowledge of the psychological factors affecting individual patients can get in the way.

Know Your Alternatives

Most doctors reflexively turn to opioid pain care for surgical patients, and that makes continuing education and establishment of alternative pain management protocols vital to success. Just as doctors have been steadily reducing opioid use for non-surgical patients, they can learn to adjust their treatment standards for surgical patients.

One common approach to managing pain in hospital patients, whether or not they’re surgical, is the development of pain management pathway protocols. That means doctors follow a specific sequence when prescribing pain relief medications, starting with the least intense and moving up to more serious medications over time. A complete protocol also includes pain management supplements or alternatives like massage, physical and occupational therapy, nerve blocks, and muscle relaxers.

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Currently, a number of companies are researching alternatives to opioid pain management and it’s important your hospital remain engaged with those new treatments. At Heron Therapeutics, for example, researchers are currently seeing success with HTX-011, a non-opioid pain reliever. Though still in early research, HTX-011 has allowed doctors to perform surgery and eliminate or reduce opioid use for up to 72 hours after surgery.

Don’t forget that small, added supports such as the option to attend AA/NA meetings in hospital, meet with an addiction counselor, or receive buprenorphine or other addiction preventatives can be enough to bridge the care gap for patients struggling to manage their pain and their addiction simultaneous. Though we regularly claim to prioritize holistic care, we often overlook the minor measures that can make a major difference.

Former addicts can’t forego pain treatment when undergoing surgery, but they also can’t receive standard treatment without added support. That’s why it’s time for hospitals to become addiction informed. Treating individuals in recovery will become increasingly important in the next several years as we continue to address the opioid epidemic ravaging communities across the nation. Addiction aware treatment is the new standard of care.