and are at high risk for drug tolerance, and maybe even addiction.
Dr. Wagner I work in a high-volume orthopedic hospital — we do
about 20,000 joint replacements a year and 39,000 total procedures
annually, everything from complex spine reconstruction to outpatient
bunion surgeries and everything in between — so patients have
severe pain when they go home. Opioids are still the primary treat-
ment modality for severe pain. We haven't found a complete substi-
tute. We'd like to, but we haven't yet.
Dr. Stamatos Opioids are there to kill pain. The other side of the coin is
abuse. It's a wonderful thing if you can get away from using narcotics.
But to say we're going to do this opioid-free isn't a reasonable goal.
Shoot for getting down to the minimal amount, and doing everything
you can to stay away from that class of medications.
Dr. Viscusi We do need to think about the amount of opioids pre-
scribed that aren't warranted, that collect in home medicine cabinets,
where they're available for abuse and diversion. Opioids prescribed
without clear indication contribute to the well of drugs that aren't
consumed, which is now a recognized problem. So the issue is com-
plicated, and it takes a lot of effort. You see clear benefits in reducing
the use of opioids, but trying to prove those benefits to caregivers and
patients can be challenging.
Dr. Wagner Patients expect their pain to be managed. They don't
expect opioids, although there are plenty of people who say they'd
rather avoid them, if possible. Most patients expect they'll take
Vicodin and Percocet for some period after surgery, but most also
expect to limit the amount of time they're on those medications.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | February 2015
