Rethinking Post-Surgical Painkillers

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New federal guidelines advise primary care doctors to consider carefully when prescribing of opioid painkillers, and in an editorial a team of surgeons has recommended what the American Council on Science and Health testified to at the FDA in February; cutting back on the number of opioid pills prescribed to patients after surgery.

It’s not unusual for a surgery patient to be sent home with dozens of pills, many of which get relegated to the medicine cabinet, and sometimes taken by kids or sold. Partly due to that, about 5 million Americans misuse prescription opioid pain relievers, and many of the abused drugs initially are prescribed by doctors and then taken from medicine cabinets.

Such non-medical use has a huge price tag. The CDC estimates that misuse of such drugs costs the U.S. economy more than $70 billion annually, including health-care costs, lost time at work and criminal justice costs.

Writing in Anesthesiology, anesthesiologist Evan D. Kharasch, MD, PhD, and surgeon L. Michael Brunt, MD, suggest new approaches for administering and prescribing pain medications to surgery patients.

“There has been a trend to use opioid medications that wear off more quickly in surgery patients,” Kharasch said. “But what if we were to use longer-duration drugs during surgery so that patients were more comfortable for a longer time after an operation? Would that mean they would need fewer pain pills when they go home? That’s something that needs to be studied.”

Brunt and Kharasch believe that limiting the supply of prescription opioids in the community could result in big benefits, by reducing the number of people who abuse those drugs or become addicted. It also could lower rates of heroin use because as more people have become dependent on prescription opioids and as opioids have gotten more expensive, many of those users have switched to heroin.

Citation: Kharasch ED, Brunt LM. Perioperative opioids and public health. Anesthesiology vol. 124 (4), April 2016.