A medical study is challenging the federal government’s one-size-fits-all solution to stop the overprescribing of painkillers.
The study says that for certain procedures, opioids can be prescribed safely for five days to as long as two weeks; federal guidelines say opioid prescriptions should not exceed seven days.
“The overprescription of pain medications has been implicated as a driver of the burgeoning opioid epidemic; however, few guidelines exist regarding the appropriateness of opioid pain medication prescriptions after surgery,” says the study, whose findings were published Wednesday in the Journal of the American Medical Association.
The study was led by Dr. Rebecca Scully of Brigham and Women’s Hospital, a nonprofit teaching affiliate of Harvard Medical School.
Last year, the Centers for Disease Control and Prevention issued guidelines for painkillers, noting that opioid abuse and addiction often start with the overprescription of opioids for acute pain, including after surgery. The CDC recommends that immediate-release opioids be prescribed for at least three days and rarely for more than seven days.
Last week, CVS pharmacies announced that they would require pharmacists to double-check opiod prescriptions that are longer than seven days or aren’t for immediate-release pills.
“Although 7-day limits on initial opioid pain medication prescriptions are likely adequate in many settings, and indeed also sufficient for many common general surgery and gynecologic procedures, in the postoperative setting, particularly after many orthopedic and neurosurgical procedures, a 7-day limit may be inappropriately restrictive,” the study says.
Researchers followed 215,140 people ages 18 to 64 who had not previously used opioids and were part of the Department of Defense Military Health System. The patients underwent one of eight common surgical procedures, including appendix and gallbladder removal, hernia repair, hysterectomy and mastectomy, and ligament repair.
The average length of an opioid prescription was four to five days, and about 19 percent of participants needed prescription refills for pain medication.
“In practice, the optimal length of opioid prescriptions lies between the observed median prescription length and the early nadir, or 4 to 9 days for general surgery procedures, 4 to 13 days for women’s health procedures, and 6 to 15 days for musculoskeletal procedures,” the study concludes.
An accompanying editorial, however, stresses that physicians should not overprescribe pain medication to prevent follow-up phone calls from patients requiring refills.
“It is key to remember the importance of setting expectations in the interpretation of pain,” wrote Dr. Selwyn Rogers, chief trauma surgeon at the University of Chicago Medical Center. “Unfortunately, we have reached a point that 100% elimination of pain has become not only the goal but the expectation. If a surgeon allows a patient to expect a pain-free recovery, he or she will see refill requests increase.”
Dr. Rogers said surgeons and prescribing physicians need to prepare patients for discomfort, advise them about the use of acetaminophen and ibuprofen, and follow up with stronger medications only if the pain is not adequately relieved.
“Beyond the itching, nausea, constipation and nightmares associated with opiate medications are addiction and death. We should do our part to alleviate this burden on our patients,” he wrote.
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