Opioid epidemic impacts on orthopaedic care
The use of opioids for pain management after orthopaedic surgery is on the rise, often with unanticipated consequences, according to the authors of a new literature review published in The Journal of the American Academy of Orthopaedic Surgeons.
Orthopaedic surgeons are the third highest prescribers of opioids for the treatment of pain in the United States, and the USA makes up less than five per cent of the world’s population but consumes 80 per cent of the global opioid supply – and approximately 99 per cent of all hydrocodone, the most commonly prescribed opioid in the world.
“The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing,” said study co-author Hassan Mir, associate professor of orthopaedics and rehabilitation at Vanderbilt Orthopaedic Institute. “Management of pain is an important part of patient care; however, the increased usage of opioids for the treatment of pain has led to several unanticipated after-effects for individual patients and for society at large.”
Opioids are now more frequently prescribed for the treatment of chronic conditions, including musculoskeletal pain of the spine and limbs, whereas prescriptions for non-steroidal anti-inflammatory drugs and paracetamol have remained constant.
The unanticipated consequences of the increased usage of opioids for pain management include the unlawful sale or sharing of opioid medications with others; if used inappropriately, death from addiction and unintentional overdose can result.
“Orthopaedic patients can experience a tremendous amount of pain with acute injuries and chronic conditions, and the treatment plan may involve opioid prescriptions for relief of discomfort,” said Mir. “A significant number of orthopaedic patients and their families are at risk for repercussions from opioid use. We must work together with all prescribers and patients to decrease the use of opioids for musculoskeletal pain.”
Study co-author Brent Morris, a shoulder and elbow surgeon with the Lexington Clinic Orthopedics Sports Medicine Center, added: “A comprehensive strategy of risk assessment is needed to identify patients who may be at risk for opioid abuse. Objective measures including patient history, recognition of aberrant behavior, urine drug testing, and opioid risk-assessment screening tools may be necessary in select cases.”
Morris, B.J. & Mir, H.R. (2015) The opioid epidemic: impact on orthopaedic surgery. J. Am. Acad. Orthop. Surg. 23, 267–271 doi: 10.5435/JAAOS-D-14-00163