Opioid Safety, Respiratory Compromise

The Epidemic of Opioid OverPrescribing Suggests the Need for Caution and Careful Monitoring

Recent research has found that opioids are being overprescribed to patients.

A study at the Johns Hopkins University School of Medicine has found that opioids are being overprescribed to children.

Myron Yaster, MD (Richard J. Traystman Distinguished Professor, Departments of Anesthesiology, Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine) and his colleagues interviewed the patients of pediatric patients who had been given opioids upon discharge from hospital. They were looking to determine:

  • whether the prescriptions were filled;
  • whether the pain was controlled;
  • how long the opioids were used;
  • how much drug was left at the completion of therapy;
  • whether patients were given instructions regarding disposal of leftover drugs; and
  • whether the remaining drug was discarded.

Dr. Yaster says that the survey results show that clinicians are doing a good job at making sure that pain is treated; however, 60% of dispensed opioids were not used and 90% patients and their parents were not told how to discard the unused prescribed opioids. The result, according to Dr. Yaster, is a “national catastrophe”:

Overprescribing of Opioids to Peds Leads to Abuse

Overprescribing of Opioids to Peds Leads to Abuse

These research findings echo the results of a study of opioid prescriptions following low-risk surgeries by Mark Neuman, MD, MSc, (Assistant Professor, Anesthesiology and Critical Care; Director, Penn Center for Perioperative Outcomes Research and Transformation) and his colleagues:

The new study, which included researchers from the University of Toronto, analyzed insurance claims from 2004 through 2012 for 155,297 adults undergoing four common outpatient surgeries — carpal tunnel repair, laparoscopic gall bladder removal, some minimally invasive knee surgeries, and hernia repair. In an analysis of patients who had not received an opioid prescription in the six months preceding surgery, the researchers observed that four out of every five patients in the study filled a prescription for an opioid pain medication within the seven days after surgery. The percentage of patients who got those drugs increased over for the period studied all four surgical procedures.

Most notably, the amount of opioid medication dispensed to patients after surgery also increased markedly between 2004 and 2012 for all procedures studied. Among patients undergoing knee arthroscopy, for example, the investigators estimated a greater than 18 percent increase in the average total amount of opioid dispensed, driven by a change in the average daily dose.

In a webinar on reducing adverse drug events and harm associated with postoperative opioid pain management programs, healthcare experts and patient safety advocates emphasized that the management of pain must follow the continuum of care – from the treatment selection to the monitoring of patients receiving opioids. As Chris Pasero, MS, RN-BC, FAAN (Pain Management Educator and Clinical Consultant) explained:

When someone has some mild pain, we give them opioids. They have a little more pain, we give them more opioids. They have severe pain, we give more opioids. And, of course, at the top of this pyramid is where we see adverse events including patient deaths. What’s happening nation-wide is a focus on opioid-only treatment plans. This is problematic.

Four factors were cited as keys to better pain management:

  1. Multi-modal pain plans provide better pain relief and result in fewer adverse events than opioid-only pain treatment plans.
  1. Educating patients and families about opioid PCA (patient-controlled analgesia) pumps leads to better clinical outcomes.
  1. Respiratory monitoring technology such as capnography and pulse oximetry can aid in patient assessments and prevent serious adverse events.
  1. As many as 50 percent of PCA-related adverse drug events could be prevented with effective monitoring.

 

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