As we follow the national opioid epidemic, with its greater than five deaths per hour from opioid overdoses, the focus is shifting to methods for limiting an individual’s exposure to these drugs. For most of us, our first contact with these highly addictive medications is after surgery.
Studies now reveal that 60 percent of pills prescribed for pain after surgery go unused. These opioids often make their way to other family members, are kept for continued use by the surgical patient to maintain a feeling of euphoria, or even find their way out into the community. Limiting the number of pills and refills prescribed is a good start, but should we consider not using opioids, or discharging surgical patients on them, at all? With the advent of new anesthetic techniques and a long-acting nerve-blocking medication, this option is now a reality. We shall look at two commonly performed surgeries where we are seeing a spike in opioid dependence in relatively young, healthy patients.
Shoulder surgeries and cesarean sections occur on a daily basis across the country. With over 700,000 shoulder procedures and over one million cesarean sections performed each year, thousands of these young-adult patients will go on to be persistent opioid users. There are several pre-existing conditions that can contribute to continued use, such as whether a patient is a smoker or has been diagnosed with alcohol- or drug-based issues or depression, anxiety or chronic pain conditions before surgery, but that is beside the point. It goes without saying that individuals with a genetic or behavioral predisposition to abuse opioids should be forewarned and treated accordingly, but why not avoid the opioid exposure issue with these patients altogether?
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