Hospital creates a guideline for surgeons to prescribe opioids

Dartmouth-Hitchcock Medical Center developed guidelines for surgeons to send patients home with fewer opioid painkillers.

A medical center used a simple idea to reduce the number of opioids it prescribes to patients: It provided surgeons with guidelines on how many pain pills to send home with patients after a specific surgery.

The surgical department at Dartmouth-Hitchcock Medical Center in New Hampshire created guidelines that suggested surgeons limit prescriptions of opioid painkillers to a specific number based on the type of surgery a patient underwent, according to a new study published by the Annals of Surgery.

The result: Surgeons reduced prescriptions for opioid painkillers by an average of 53% while still providing effective pain relief for patients, the study found. That action, if replicated in other hospitals, could help curb the country’s opioid epidemic since drugs are overprescribed and those not used by patients may get diverted to other people, which is a major contributor to rising deaths from overdoses, Richard J. Barth, Jr., M.D., chief of general surgery, said in a study announcement.

Researchers found there was a wide variation in the number of opioids prescribed to patients who undergo the same surgery. For instance, doctors prescribed anywhere between 10 and 100 pills for patients undergoing gall bladder surgery. Barth said even veteran surgeons had no idea how many opioids to send home with patients.

To come up with guidelines, researchers evaluated 642 patients who underwent five common outpatient procedures and tabulated their opioid prescriptions and refills. They then conducted a phone survey to determine the number of pills patients actually took and found that most did not use all of the pain medicine and less than 2% of patients obtained refills.

They identified the number of pills that would supply the needs of 80% of patients undergoing each surgery. Using those numbers, surgeons can treat postoperative pain and decrease the number of opioids prescribed, the study concluded. Doctors were also encouraged to recommend patients use non-opioid painkillers.

“Our ability to decrease opioid prescribing and use with an educational intervention at our institution implies that similar educational efforts at the state and national level will also be successful in markedly decreasing opioid prescribing by surgeons on a broader scale,” Barth wrote.

With drug overdoses continuing to rise as the leading cause of injury death in the U.S., the Centers for Medicare & Medicaid Services has made curbing the opioid epidemic a top priority. Research has also found that drug users often get their prescriptions from primary care providers.