SURGERY
If you’ve turned on a television recently, you’ve more than likely heard about the opioid epidemic that is sweeping across America. In the medical setting, opioid medications are utilized to relieve pain. Unfortunately, these medications have many side effects, including (but not limited to) constipation, sedation, respiratory depression, and euphoria. In addition, tolerance and dependence can develop with chronic use, which can result in increasing dosages and withdrawal symptoms upon abrupt discontinuation.
The associated euphoria that some people experience with opioid use has attracted recreational use, which can subsequently lead to addiction. Stories of heroin, oxycodone, and Vicodin abuse are becoming relative commonplace. According to the New York Times, opioid abuse has been associated with approximately 33,000 deaths in the United States alone in 2015. Rhode Island, unfortunately, is not immune to the effects of opioids. Over the past 5 years, over 1,000 Rhode Islanders have died from opioid abuse.
In response to increasing use of opioids, Governor Raimondo has said that “drug overdoses represent a public health crisis that is as urgent as any we have ever confronted in Rhode Island.” She has developed a Strategic Action Plan with the following goals:
• Develop, implement, and enforce regulations that limit most opioid dosing to a contained period of time, with exceptions for high-need patients;
• Develop clinical guidelines for co-prescribing opioids and benzodiazepines;
• Aggressive, targeted sanctions to ensure universal enrollment in the Prescription Drug Monitoring Program;
• Create a centralized and sustainable fund to maintain an adequate supply of naloxone, which can reverse the effects of a drug overdose;
• Open Rhode Island’s first Center of Excellence before the end of 2016;
• Expand medication-assisted treatment to the Department of Corrections;
• Double the number of certified peer recovery specialists by March 2017;
• Create a model discharge and recovery plan to promote recovery services for patients with substance use disorder.
The primary goals of the Strategic Action Plan have directly impacted medical providers. Effective March 22, 2017, regulations for prescribing opioids for acute pain have been initiated. In the orthopedic setting, this directly affects patients undergoing surgery or those experiencing acute traumatic injuries. Prescriptions for acute pain for an individual who has not received opioid medications in the outpatient setting within the last 30 days cannot receive a prescription for more than twenty doses as directed by the Rhode Island Department of Health.
As a medical provider, I recognize that surgical procedures or acute fractures are associated with significant pain that may necessitate opioid medications. In response to the worsening opioid epidemic, however, I appreciate the steps that the Department of Health are enacting to combat opioid abuse and support the intent of their efforts. As my prescribing habits are altered (and I’m sure that I speak on behalf of all providers at Orthopedics Rhode Island), I apologize for any inconvenience that these new regulations have been placing on our patients. We have been in discussions with representatives of local politicians to make the new policies as patient-friendly as possible.
