Orthopedic Patients and Their Families At Risk For Opioid Abuse

Hassan R. Mir, MD, MBA Associate professor of Orthopaedics and Rehabilitation Vanderbilt Orthopaedic Institute MedicalResearch.com Interview with:
Hassan R. Mir, MD, MBA
Associate professor of Orthopaedics and Rehabilitation
Vanderbilt Orthopaedic Institute and

and

Brent J. Morris, M.D. Shoulder and Elbow Surgery Fellowship Texas Orthopaedic Hospital in affiliation with the University of Texas Houston Health Science Center, Houston, Texas Dr. Brent J. Morris, M.D.
Shoulder and Elbow Surgery Fellowship
Texas Orthopaedic Hospital University of Texas Houston Health Science Center,
Houston, Texas

Medical Research: What is the background for this study? What are the main findings?

Dr. Mir: The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing. The US represents less than 5% of the world’s population, yet consumes 80% of the global opioid supply. Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large.

Orthopaedic surgeons are the third highest prescribers of opioid prescriptions among physicians in the United States. Orthopaedic patients can experience a tremendous amount of pain with acute injuries and chronic conditions, and the treatment plan may involve opioid prescriptions for relief of discomfort. A significant number of orthopaedic patients and their families are at risk for repercussions from opioid use. We must work together to decrease the use of opioids for musculoskeletal pain.

Clinicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. A comprehensive strategy of risk assessment is needed to identify patients who may be at risk for opioid abuse. Objective measures including patient history, recognition of aberrant behavior, urine drug testing, state prescription drug–monitoring programs, and opioid risk-assessment screening tools may be necessary in select cases.

Medical Research: What should patients and clinicians take away from your report?

Dr. Mir:

3 tips for patients:

  • Ask your doctor about ways to control your pain with minimal use of opioids.
  • Do not seek opioids from multiple physicians as “doctor shopping” for pain medication is dangerous.
  • Seek help if you or a family member are becoming dependent on opioids.

3 tips for clinicians:

  • Counsel patients and establish reasonable expectations for pain as a part of treatment plan discussions and follow-up visits.
  • Establish a standard pain protocol for specific surgical and nonsurgical treatment plans with an opioid taper.
  • Be aware of available objective risk-assessment tools and state prescription drug monitoring programs to use as adjuncts to clinical experience and judgment when dealing with challenging patient scenarios.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Mir: There are several areas of potential research with regard to opioid medications and musculoskeletal pain, many of which are already underway looking at the potential detrimental effects of opioid medications on clinical outcomes. Other areas for potential research include alternative multi-modal pain control regimens, clinician education, patient education, electronic health records, clinical practice guidelines, and prescription drug monitoring programs all as means to decrease the widespread use of opioid medications for musculoskeletal pain in the United States.

Citation:

J. Morris, H. R. Mir. The Opioid Epidemic: Impact on Orthopaedic Surgery. Journal of the American Academy of Orthopaedic Surgeons, 2015; 23 (5): 267 DOI: 10.5435/JAAOS-D-14-00163

MedicalResearch.com Interview with: Hassan R. Mir, MD, MBA, Associate professor of Orthopaedics and Rehabilitation, & Vanderbilt Orthopaedic Institute (2015). Orthopedic Patients and Their Families At Risk For Opioid Abuse