Dr Sean C. Dowdy: Reducing Opioid Abuse in Patients Undergoing Surgery for Gynecologic Malignancies

It’s important to emphasize that this is not an opioid crisis, it’s a prescription opioid crisis, said Sean C. Dowdy, MD, chair, division of gynecologic surgery, department of obstetrics and gynecology, Mayo Clinic.

Transcript

What interventions have been put in place to reduce opioid abuse in patients undergoing surgery for gynecologic malignancies?

The first part is just awareness. I think it’s important to emphasize that this is not an opioid crisis, it’s a prescription opioid crisis. For instance, Prince and Tom Petty, they didn’t die of heroin overdoses, they died of prescription fentanyl overdoses. So, while I think the pharmaceutical companies bare some responsibility, the fact is that patients get their prescriptions from physicians, so we really need to take charge of this and have a response to how to deal with this.

So, the first past is awareness. The second apart is, again, just making a change to our practice. We need to inject incisions so patients have better pain control, we need to optimize nonopioid alternatives, like ibuprofen and Tylenol, and patients need to be educated about this, as well. We shouldn’t just give every patient a prescription for oxycodone when they leave the hospital. They should only get it if they need it, and if they get these prescriptions, they should be in relatively small amounts.

For example, for patients with ovarian cancer surgery, this is a big laparotomy from pubic synthesis to xiphoid process, our guidelines are that the patients only get 10 pills when they leave the hospital. We have not seen an increase in refills, and patients still have good pain scores. So, really, we’ve been overprescribing pretty significantly before that change.