Patients should be screened and treated for substance abuse disorders before elective surgery is performed, researchers urge.
Post-operative pain is an accepted part of most surgeries, including elective operations. But in recent years, increased opioid prescribing has been closely linked to increases in opioid overdose, according to a special topic paper in the October issue of Plastic and Reconstructive Surgery®, the medical journal of the American Society of Plastic Surgeons (ASPS).
"Surgeon opioid prescribing practices contribute to the opioid addiction crisis," wrote Daniel Demsey, MD, of University of British Columbia, Vancouver, and colleagues. "Improvements in prescribing practices can improve patient safety."
The paper includes the following recommendations to help plastic surgeons become part of the solution:
1. Patients should be screened for risk factors for opioid use disorder, which include previous substance use disorders, mental health problems such as anxiety or depression, being female, and low socioeconomic status. Note that patients who have never taken opioids before can still be at risk of persistent use.
2. Physicians should talk to patients about the risks of opioid addiction and diversion in a nonjudgmental way and encourage them to use and store their medications properly.
3. Physicians should refer patients with known or suspected substance use disorders to an addiction specialist, preferably before surgery, and consider referral to a transitional pain service after the surgery and development of an opioid weaning plan.
4. Plastic surgeons should inform patients’ primary care doctors about possible increased risks linked to opioid prescriptions.
5. Consider the use of combination anesthesia techniques and prescribing nonopioid pain medications after surgery.
"Although we cannot solve the opioid addiction crisis on our own, as plastic surgeons we can make a major contribution,” Demsey said.
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.