Plastic surgeons must recognize their patients' risk of developing opioid use disorders and that the opioids they prescribe may be diverted to non-medical use, urges Daniel Demsey, MD, of the University of British Columbia, Vancouver, and colleagues in the October issue of Plastic and Reconstructive Surgery®.
"Surgeon opioid prescribing practices contribute to the opioid addiction crisis," Dr. Demsey says in a news release. “Although we cannot solve the opioid addiction crisis on our own, as plastic surgeons we can make a major contribution.”
Risk factors for persistent opioid use include previous substance use disorders, mental health problems such as anxiety or depression, female sex and low socioeconomic status. Patients with chronic pain who are already taking opioids are at higher risk of complications or death after major surgery and incur higher health care costs.
Many patients don't use all the opioid medications prescribed after surgery, with a risk that these leftover drugs will be diverted to nonmedical use by the patient or others. Most people with prescription opioid use disorder get the drugs from friends and family.
To reduce the risks of persistent opioid use or diversion, patients should be screened for risk factors for opioid use disorder. Surgeons should talk to patients about these risks in a nonjudgmental way to encourage them to use their pain medications cautiously. The patient's primary care doctor should also be informed about the possible increase in risk.
For patients at risk, outcomes can be improved by referral to a transitional pain service, including development of an opioid-weaning plan. Patients with known or suspected substance use disorder should be referred to an addiction specialist, preferably before surgery.
Other strategies can help to reduce the need for opioids, including the use of combination anesthesia techniques and prescribing nonopioid pain medications after surgery.
Moreover, educating patients about proper storage and disposal of opioid medications can help to reduce the risk of persistent opioid use or diversion.