A Brief Colonial History Of Ceylon(SriLanka)
Sri Lanka: One Island Two Nations
A Brief Colonial History Of Ceylon(SriLanka)
Sri Lanka: One Island Two Nations
(Full Story)
Search This Blog
Back to 500BC.
==========================
Thiranjala Weerasinghe sj.- One Island Two Nations
?????????????????????????????????????????????????Saturday, May 6, 2017
How 30 Opioid Pain Pills for Surgery Turn into a Habit
A small number of people—about 6 percent—who had not been taking opioids
before an operation, but got them to ease post-surgery pain, are still
taking painkillers three to six months later. That’s long after what is
considered normal for surgical recovery.
Smokers and those who had a history of alcohol or drug issues were about
30 percent more likely to keep filling prescriptions. People with
arthritis were more than 50 percent more likely to do so.
A new study suggests that certain factors make these “opioid-naïve”
surgery patients more likely than others to end up refilling their
opioid prescriptions for months despite a lack of evidence that the
drugs help chronic pain or other long-term issues.
There are more than 50 million surgical procedures in the United States
each year. If the new findings hold true for all patients, that would
mean about 2 to 3 million people end up taking opioids for months after
an operation.
“This points to an under-recognized problem among surgical patients,”
says Chad Brummett, the director of the Pain Research division in the
University of Michigan Medical School anesthesiology department and
first author of the study in JAMA Surgery.
“This is not about the surgery itself, but about the individual who is
having the procedure, and some predisposition they may have. And we know
that continued opioid use is probably not the right answer for them.”
Brummett and colleagues are working to find better ways for surgical
teams to predict and manage the risk of long-term opioid use among their
patients.
“These results show the need for education of surgical providers, to
understand when it’s time to stop writing prescriptions for opioids, and
to refer patients for assistance from a chronic pain physician,”
Brummett says. “We need to be asking patients why they think they still
need opioids, and what they’re being used for, not just refilling.”
125 pills
The team drew their findings from more than 36,000 non-elderly adults
with private insurance who had only one operation in a two-year period
from 2013 to 2014. None had had an opioid prescription for the year
preceding their operation.
About 80 percent of the patients had minor operations to remove varicose
veins, hemorrhoids, appendixes, prostates, thyroids, and gallbladders,
or address hand issues—often through minimally invasive techniques. The
rest had major operations such as bariatric surgery, hysterectomy,
hernia repair, or surgery to address severe reflux or remove part of
their colon.
On average, the patients received a prescription for 30 to 45 tablets of
opioids in the weeks immediately before or after their operation. Many
surgical practices pre-approve such prescriptions for patients during
the pre-operative period so they can fill them before they go to the
hospital and have them on hand when they get home.
For the 6 percent or so who were still filling opioid prescriptions
three to six months after their operation, the average number of total
post-surgery prescriptions was 3.3, adding up to about 125 pills. Other
research has shown that long-term prescription opioid use raises the
risk of becoming dependent on the drugs for non-medical reasons, or
moving to illicit opioid drugs like heroin.
Still a new idea
New chronic pain is a known risk of surgery, and some operations do
require opioid use for more than a week or so to control acute pain.
Surgeons may even worry that if they limit opioid prescriptions, it will
lower the patient-satisfaction scores that can affect how much they are
paid by insurers, or cause their staff to have difficult interactions
with patients.
But Brummett points to Centers for Disease Control and Prevention
guidelines that state clearly that opioids are not appropriate
first-line medications for long-term pain control.
The data came from IHPI’s store of anonymous private-insurance claims data purchased from Optum.
The comparison group included a randomly selected 10 percent sample of
adults who did not have surgery or an opioid prescription in a one-year
period. The researchers assigned them a fictional “surgery date” and
looked for any opioid prescriptions they filled in the 180 days after
that.
“To truly confront our nation’s opioid issues, we need to move upstream,
toward a preventive model that focuses on the 80 percent of our
surgical patients who are not taking opioids,” Brummett says.
“From our interactions with surgeons and their teams through
Michigan-OPEN, it’s apparent that it’s still a new idea to many that the
prescription they write for a surgery patient is a potential source for
new chronic use and even diversion of opioids.
“Surgeons and their teams want to do the right thing, so we need to help
them shepherd patients through the surgical path and help them come out
healthier.”
The Michigan Department of Health and Human Services and the National
Institutes of Health and the Agency for Healthcare Research and Quality
funded the work.
Source: University of Michigan