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Recognizing that physician prescriptions play an important role in the opioid crisis in Canada, a team of researchers developed a program called STOP Narcotics to dramatically reduce the number of badgesic patients treated after routine operations.
In a study presented Wednesday at the clinical conference of the American College of Surgeons in Boston, researchers at Western University revealed that the STOP Narcotics protocol halved the number of opioids prescribed after two types outpatient surgery, while maintaining adequate postoperative pain management for most patients. .
"By dramatically reducing the amount of opioids prescribed, this reduces the risk of exposure and the risk of misuse of narcotics," said Dr. Luke Hartford, senior author, resident of General Surgery at the University of Toronto. 39, University of London, Ontario.
"It also reduces the excess of drugs available to be routed to people for whom they are not intended," he said, pointing out that the STOP Narcotics program included a combination of patient education and health care providers, the focus being on the control of non-opioid pain.
The study, published Wednesday in the Journal of the American College of Surgeons, looked at 416 patients at the London Health Sciences Center and St. Joseph's Health Care, who had undergone laparoscopic gall bladder removal or an open hernia repair.
About half of the patients were randomly badigned to either a control group receiving a standard opioid prescription, or to the STOP Narcotic protocol group, who was prescribed acetaminophen and an anti-inflammatory to manage postoperative pain during the first 72 hours. after their operations.
Under the protocol, surgeons were instructed to write an opioid prescription of 10 tablets, which expired seven days after surgery. Patients were only required to complete this prescription if they were not able to properly control the pain with the other medications.
Prescribed opioids halved
"Ninety percent of patients reported that they had pain control and did not need the drug text filled," said lead researcher Dr. Ken Leslie. General Surgery at the London Health Sciences Center.
The researchers found a 50% reduction in the number of opioids prescribed by surgeons in the Narcotic STOP group compared to the control group.
In addition, just 45% of patients in the protocol group completed their opioid prescription, compared to 95% of the control group.
"So we not only halved the amount we prescribed, but we also found that [less than] Half of the patients actually fulfilled these requirements, "Hartford said, adding that" only a very small number "needed opioids for additional pain control.
"We also found that in our control group, even if we prescribed 20 to 30 opioid tablets to patients, they only took about seven," he said.
People tend to hang on to additional opioids
That's why the STOP Narcotics initiative has another goal: to significantly limit the amount of unused opioids that can be diverted for recreational purposes, particularly by those at risk of finding them in the family practice. .
As part of the postoperative program, patients were asked to return the remaining opioids to their pharmacy or hospital for disposal. The researchers found that the return rate was 7% in patients in the control group, compared with 23% in patients in the STOP Narcotic group.
"It's really hard to get people to give up something that they have at home," Leslie said. "They hang in case they hurt at the end of the road."
Surgeons often say that they prescribe "a lot of pills" to make sure patients have enough at their disposal to manage their pain – but also to avoid renewal calls at their desks, Leslie said.
But the study found that turnover rates were low: 3.5% for opioids initially prescribed and 2.5% for patients with protocol.
"We recognized that before STOP Narcotics, every surgeon had a different approach to pain control and that most surgeons prescribed more narcotics than he really needed," he said. Leslie. "When we examined the data from this new protocol, we found that the patient's pain control was just as effective with this pathway, with no huge prescription of narcotics."
Dr. David Juurlink, Head of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Center in Toronto, said the Western study was not the first to show that a more cautious prescription of Post-surgical opioids could be beneficial for patients, but "it's an important element .. nevertheless subject."
"There is more and more talk that the opioid crisis is actually about drug addicts who are dying by the thousands and that pain treatment is not the problem," said Juurlink, who says the drug is not the problem. did not participate in the study.
"And that's not true … It's also to a large extent how we manage acute and chronic pain."
Juurlink said that whenever a patient receives more opioids than he needs – whether for chronic pain or after surgery or dental intervention – he may take longer than necessary, or the remaining tablets may remain in the medicine cabinet and offer temptation to an experienced teenager or a person who may be at risk of addiction.
"So, I think the more surgeons will adopt this type of practice – not to avoid opioids but to prescribe them more wisely – more patients will be well off and society too."
Western researchers hope to expand the STOP Narcotics initiative beyond general surgery to encompbad other specialties, such as gynecology and orthopedics, and possibly for some hospital operations.
The protocol has already been presented to a few hospitals in southwestern Ontario, which have adopted it, and researchers must present the program elsewhere in the coming months.
Leslie stated that there were approximately 45,000 laparoscopic gallbladder removal and open hernia repair operations performed annually in Ontario, and that the application of STOP Narcotics to these two operations would only allow for remove almost one million opioid tablets from the circulation.
"Our message is not that narcotics or opioids are inherently bad," added Hartford. "These are excellent drugs when they are used properly, but they also have significant side effects – constipation, nausea, confusion in older patients.
"This is only one of the many things you can do to relieve someone's pain after surgery."
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