Orthopedic Surgeons Advised to Limit Opioids

By Pat Anson, Editor

The American Academy of Orthopaedic Surgeons (AAOS) has joined the chorus of physician organizations calling for greater efforts to address the “growing opioid epidemic” in the U.S.

The AAOS Board of Directors has adopted an Information Statement on Opioid Use, Misuse and Abuse in Orthopaedic Practice that calls for limits on opioid prescribing and improved efforts to educate physicians, caregivers and patients about opioid misuse.

Orthopaedic surgeons are the third highest prescribers of opioids behind medical doctors and dentists, according to the AAOS.

"A culture change has created the current opioid epidemic, and only a culture change -- led by physicians unafraid to limit opioid prescriptions -- will solve the epidemic," said David Ring, MD, a member of the AAOS Patient Safety Committee. "It's up to us to treat pain with less dependence on opioids. This information statement outlines the steps and strategies to help get us there."

Among the recommendations:

Standardized opioid prescribing policies that set ranges for acceptable amounts and duration of opioids for various surgical and non-surgical conditions and procedures. Opioids should not be prescribed for pre-operative and non-surgical patients.

Patients at greater risk for opioid use, such as those with symptoms of depression and poor coping strategies, should be identified and treated for these conditions prior to elective surgery.  

Surgeons should practice empathetic and effective communication. Patients are more comfortable and use fewer opioids when they know their doctor cares about them.

Partnerships need to be established among hospitals, employers, patient groups, state medical and pharmacy boards, law enforcement agencies, pharmacy benefit managers, insurers and others to combat opioid abuse.

Improved opioid tracking. A single nationwide tracking system would allow surgeons and pharmacists to see all prescriptions filled by a given patient.  

Physicians should be stricter about prescribing opioids and monitor their effectiveness..

Health care providers must recognize that patients with terminal illnesses and “other appropriate conditions” should have access to opioids.

The recommendations also call for an “opioid culture change.”

“Making opioids the focus of pain management has created many unintended consequences that often put both patients and their families at increased risk of addiction and death. Peace of mind is the strongest pain reliever. Studies have found that opioids are associated with more pain and lower satisfaction with pain relief,” the AAOS guidelines state.

The AAOS represents over 40,000 physicians and health care providers in osteopathic and orthepaedic medicine. It is one of 27 physician organizations that have joined the American Medical Association’s Task Force to Reduce Opioid Abuse.