SURGEONS REFLECT ON ROLES IN OPIOID CRISIS [+VIDEO]
By Katie Lannan
STATE HOUSE NEWS SERVICE
STATE HOUSE, BOSTON, OCT. 16, 2017.....For a patient recovering from surgery, an opioid painkiller prescription can be the first step to necessary relief.
Surgeons who gathered at the State House Monday said there's a growing focus in their offices and operating rooms on the other paths those prescriptions can lead down, as doctors rethink their procedures in light of the ongoing opioid addiction epidemic.
"I think we've been in the wrong a little on how much we prescribe, and I think we need to change our culture on how can we prescribe," Dr. Haytham Kaafarani said at an advocacy event held by the Massachusetts chapter of the American College of Surgeons. "We're not the only part of the problem, but I think there is something to it that we need to change how we do it."
During a Rose Garden press conference Monday afternoon, Trump said his administration would declare a national emergency around opioid addiction next week.
"We are going to be doing that next week," Trump said. "That is a very, very big statement. It's a very important step. And to get to that step a lot of work has to be done and it's time-consuming work."
Kaafarani, a trauma surgeon at Massachusetts General Hospital, said surgeons often believe their patients can and do take opioids without getting addicted. He said it was "eye-opening" for him to learn that of people who develop opioid abuse problems, 54 percent received their first pill from a friend or relative and almost all of those secondhand pills originally came from a valid prescription.
Allison Bauer, director of the recently renamed Bureau of Substance Addiction Services, said surgeons can "actually be on the very front line" of the opioid epidemic. [Photo: Sam Doran/SHNS]
Surgeons can play a major role in addressing the diversion of opioids, he said. Kaafarani said his hospital now offers patients information on pain management and disposal of unwanted pills, along with encouraging doctors to manage patient expectations on what level of pain is tolerable, consider alternatives like Tylenol or ibuprofen, and make sure they only prescribe a necessary supply.
A 2016 state law limited first-time opioid prescriptions for adults and all opioid prescriptions for children to a seven-day supply, and gave patients the option to partially fill a prescription. It also required that prescribers be educated on pain management and addiction.
Allison Bauer, director of the Bureau of Substance Addiction Services within the state Department of Public Health, said surgeons are on the "front front line" of the opioid epidemic, faced with a unique opportunity to determine if a patient has a history of substance use disorder and if there's another way they can manage the pain.
"You often have a patient in front of you for the first time who has actually not ever had an opioid in front of them," she said. "They may not have had to experience pain or pain management. They may be going in for a procedure that was unplanned, something that happened to them."
Dr. Peter Masiakos, the treasurer of the Massachusetts chapter of the surgeons group, said opioid prescribing accounts for one-third of what surgeons do. More than 70 percent of patients who have surgery fill an opioid prescription within one week of the operation, he said.
DPH data released in August found that the number of Schedule II opioid prescriptions logged in a state monitoring database dropped nearly 28 percent from the first quarter of 2015 through the second quarter of 2015, falling from approximately 841,990 to 638,000.
There were 978 confirmed and estimated opioid deaths in the first half of this year, according to the DPH. In the first quarter of 2017, the synthetic opioid fentanyl was present in 81 percent of overdose deaths where a toxicology screen occurred.
Deaths linked to illicit opioids like fentanyl have been "skyrocketing," Massachusetts General Hospital addiction specialist Dr. Sarah Wakeman said, indicating a shift from the prescription practices that marked the beginning phases of the epidemic.
"From a prevention standpoint, absolutely a very important intervention is to rethink our way of treating pain and the prescribing of opioids, but one thing we've seen is that we've actually begun to make some progress on that," Wakeman said. "And if we look to what is currently sustaining the epidemic, what's currently killing people, it's actually not predominantly prescription opioids."
Gov. Charlie Baker, who was scheduled to participate Monday afternoon at a National Academy of Medicine panel on opioids in Washington, D.C., said last month he is working on new legislation to address the epidemic. In August, he filed a bill that would make drug dealers subject to manslaughter charges in cases where the substance they sold led to a fatal overdose.
Lt. Gov. Karyn Polito told the surgeons that the opioid epidemic is complicated and needs to be addressed on multiple fronts, especially with the rise of deadly synthetic opioids like fentanyl and carfentanil.
"While you're doing your part on the health care end, we need to work aggressively with our law enforcement partners to go after the bad actors to make sure that these synthetic drugs stay out of this commonwealth and out of this country," she said.
[Michael P. Norton contributed reporting]
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