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  • Opioids lead to 70 percent of overdose deaths in the U.S.
  • A new survey finds that after surgery, many people would rather avoid taking opioids, but they don’t think that’s an option.
  • Experts say there are other pain management options for many people if they want to avoid opioids after some surgeries.
  • Cutting down on using opioids to manage pain after surgery may help decrease the potential for dependence and addiction.

Opioid addiction continues to take a major toll on lives in the United States. More than 70 percent of overdose deaths in 2019 — or over 49,000 deaths — involved opioids, according to the Centers for Disease Control and Prevention (CDC).

As a result, experts have been trying to find ways to limit people’s exposure to opioids after medical care to reduce the potential for dependence and addiction.

Now a new online survey conducted by Orlando Health finds many people in the United States are also interested in avoiding taking opioids after surgery if possible.

What the survey found

Nearly 80 percent of survey respondents believe opioids are necessary to manage pain after surgery, but almost 70 percent would avoid these medications if better options were available.

The survey was conducted between Oct. 19 and 21. It included 2,006 U.S. adults ages 18 and older.

The survey comes after the deadliest year for drug overdoses.

Robert Glatter, MD, an emergency physician at Lenox Hill Hospital in New York, pointed out that 2020 broke the record for fatal overdoses, with more than 93,000 deaths in the United States amid the fallout from the COVID-19 pandemic.

“The isolation and despair brought on by the pandemic led to soaring rates of depression and anxiety, compounded by job losses,” Glatter said, “which left people at higher risk for drug overdoses.”

Not necessary for every patient

Medical experts are exploring how to help patients avoid pain without relying on opioids.

Yili Huang, DO, director of the Pain Management Center at Northwell Health’s Phelps Hospital in Sleepy Hollow, New York, said opioids include some of the strongest pain relievers we have, but they’re not necessary to treat all postsurgical pain for every patient.

Huang explained that surgical pain management plans can be developed between the anesthetist, surgeon, and patient that lessens or even avoids the need for opioids.

“These plans often include alternatives such as safe and effective ways to block the nerve that may be transmitting the pain from surgery with numbing medications, and using non-opioid pain medications, such as appropriate anti-inflammatories or acetaminophen (Tylenol), as well as nerve pain medications,” he said.

Huang said wanting to avoid opioids after surgery is “definitely justified.”

He pointed out that opioids are just one class of pain medication that treat pain in a very specific way, and while opioids are effective in the right cases, there are many other pain management options.

“Let’s not forget pain response and sensation based off of a complex interplay of different signals, nerves, and emotional experiences,” Huang said. “Using different treatment strategies to target the many different areas of that complex pathway not only makes sense, but is safe and effective.”

However, Huang pointed out certain larger and more complex surgeries may still require opioids for postsurgical pain.

“In addition, certain patients who are routinely on opioids may continue [to] require opioids for postsurgical pain,” he said.

“What is certain, however, is that most surgeries do not require as many opioids as was being provided over the last few decades, and that these excess opioids have contributed to the opioid epidemic,” he added.

Huang also said that using “all the tools at our disposal” to manage surgical pain, and being judicious about postsurgical opioid prescribing, are important parts of appropriately managing postsurgical pain and recovery.

OTC drug protocol offers effective alternative

“It’s very important for us to keep in mind that people do have pain and people do need pain control. The solution is not to just pull opioids away from people and leave them to fend for themselves,” Luke Elms, MD, a general surgeon at Orlando Health Dr. P. Phillips Hospital, said in a statement.

“That is a real problem after surgery that needs to be addressed in a compassionate manner,” he continued.

Elms has implemented a protocol using common over-the-counter (OTC) drugs like acetaminophen, ibuprofen, and muscle-relaxing drugs.

Used together, these medications can offer powerful pain relief that’s more targeted to specific areas of pain, rather than the broad coverage offered by opioids.

According to Elms, the protocol also helps patients recover faster without the side effects associated with opioids, like nausea, dizziness, and constipation.

From prescription pills to illegal drugs

Glatter said while the use of prescription opioids like oxycodone is responsible for many deaths, it’s the availability of illegal opioids containing fentanyl bought online that are likely responsible for more overdoses.

Some people may have developed an opioid addiction after being prescribed opioids by a physician, and may later switch from prescription pills to illegal drugs like heroin and synthetic fentanyl.

“Fentanyl is 50 times more potent than heroin, and 100 times more potent than morphine,” Glatter noted. “Due to the higher potency, there is a higher risk that someone could stop breathing and have a cardiac arrest.”

Glatter added that the increased availability of synthetic opioid derivatives of fentanyl is an “alarming trend.”

“Recent studies support what we are seeing in the emergency department: patients requiring increasingly larger doses of naloxone to reverse the respiratory depressant effects of these powerful synthetic drugs,” he said.

The bottom line

A new survey by Orlando Health finds that most people would rather use alternatives to opioids after surgery if better options were available.

Experts say the pandemic has seen a spike in overdose deaths related to opioid misuse, making 2020 the deadliest year for drug overdoses.

They also say that there are safe and effective options to these powerful drugs that not only avoid the risk of addiction, but also opioid side effects like nausea, dizziness, and constipation.

 



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