In 2016, there were 3.3 billion opioid tablets sitting in American medicine cabinets left over from unused prescriptions. Many of these were the result of opioid overprescribing, which particularly happens after surgery. This is a finding from the report of the United States of Non-Dependence: An Analysis of Opioid Overprescribing in America, one of the resources for Plan Against Pain. This new initiative is aimed at reducing the amount of unused opioids available for misuse or possible diversion. I recently interviewed Dr. Paul Sethi and NBA all-star Grant Hill about managing postsurgical pain without opioids.
Managing post-surgery pain
NBA All-Star Grant Hill. Credit: Denisse Jonsson
“Just like in sports, you’ve got to have a game plan,” says Hill, who’s had 11 surgeries during his professional basketball career. He made the point that this plan to deal with pain after surgery should be developed in collaboration with your doctor, such as Dr. Sethi, an orthopedic surgeon.
Dr. Sethi specializes in sports medicine and is using the concept of multimodal anesthesia to help his patients manage post-surgery pain.
“The management of pain is critical,” Sethi says. It starts pre-surgical, should be intraoperative, and continued postsurgical.”
His approach includes discussing the risks and benefits of surgery and opiates before any operation.
During the operation and afterward, “we use different medications that are going to try to address pain from many different pathways.” For example, Dr. Sethi is using a long-acting local anesthetic that lasts between 48 and 72 hours, as well as other types of non-opioid medications. These different pain management tools are then combined, which leads to a better experience after surgery, reducing the need for pain medications.
In his last of eleven surgeries, Hill tried Dr. Sethi’s approach.
“It allowed me to not have to take any opioids post-surgery and I was blown away by this,” Hill says. “It was as pleasant a recovery as you can have, or at least as pleasant as I’ve had in all my surgeries during the years.”
When people who live with chronic pain have surgery, the approach can become more complicated. Dr. Sethi said that “differentiating between acute postsurgical pain and chronic pain is very challenging.” He recommends the approach be very patient-specific. He focuses on explaining “what normal pain is so that pain isn’t anxiety-provoking,” as well as employing guidelines about how many medications will be used in the post-surgery period. Over the past 15 years of using this approach, Dr. Sethi has found it to be a successful mechanism for helping patient manage post-surgical pain.
Know your options; choices matter
Research for this new initiative show that one in four people are worried about becoming addicted to opioids following surgery. But there are ways to avoid this, Hill says.
“We are here to say: ‘Look, you do have a choice,” he said. “You should talk to your doctor and as a patient you have every right to do that.”
Hill suggests talking to your doctors about pain management options, a number of which are described on the Plan Against Pain website.
“It can be a valuable resource as you’re going through and weighing your options during the surgery process,” Hill said.
What to do with unused opioids
If you have been prescribed opioids to manage postsurgical pain or other pain, but you and your doctor agree that you no longer need them, leaving them sitting in your medicine cabinet is not a great idea. It leaves it available to others, including kids in the household, and presents an unnecessary temptation. Don’t flush them down the toilet — doing so puts medication into our water supply. Instead, bring the unused part of the prescription to your pharmacist so they can dispose of it correctly.
Over-prescription of opioids is a fact. They are a fast and usually fairly inexpensive pain management option. This means they can be, at times, prescribed without adequate knowledge on behalf of the doctor or adequate education about how to take them for the patient.
However, research is conflicting. The United States of Non-Dependence report shows that nearly 10 percent of individuals who had previously not taking opioids became persistent users after surgery. Other studies disagree. Recent research by Schoenfeld et al. showed that less than one percent became persistent opioid users after an inpatient procedure. In addition, an annual large study into the issue, the National Survey on Drug Use and Health, repeatedly shows that in 75 percent of cases, opioid misuse starts when people take prescriptions that were not prescribed for them.
Finding new ways to manage postsurgical pain is always welcome and the method used by Dr. Sethi certainly shows promise. Likewise, the initiative to reduce the amount of opioids floating around unused should make it less likely for individuals to take opioids without a prescription, thereby hopefully reducing addiction rates. The key is to do this without restricting the ability and right of people who live with chronic pain to access pain management that may include opioids.
Watch the full interview with Grant Hill and Dr. Sethi.