U-M leading drive to cut opioids given after surgery

"Epidemic" is a tough word, and one often overused.

But it's now clear that we are now facing an enormous and relatively new public health epidemic from the overuse of and our growing addiction to opioid drugs.

And they aren’t all coming from back-alley pushers. Though the exact proportions are not clear, a significant percentage of opioids that enter the supply chain are prescribed by physicians, either to reduce postoperative pain or to help patients with mood disorders.

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Research conducted by the University of Michigan further shows that about one-in-10 people who were not on opioid drugs before surgery became dependent on them.

Naturally, a lot of the stuff that does get into the black market comes from pharmacy “pill mills,” corrupt doctors and faked prescriptions and drug dealers. Maybe 35 percent of all prescriptions written are for "acute care" and involve postoperative pain relief, dentistry and emergency medicine ‒ long-accepted medical practice.

I should know. Back in 2010, I had both knees surgically replaced ‒ the result of years and years of tennis, squash, hiking, fly fishing, gardening. Just after my surgery, the nurse gave me two tablets of Oxycontin. "Take these," she said.

"They'll take away the pain."

You bet they did. They also made my brain feel like mashed potatoes. When the surgeon visited me that evening, I asked him to take me off that stuff. But when I was discharged from the hospital, I was given a bottle of 50 or so Oxycontin pills to take home.

I never used them.

Since then, I must have talked to 20 relatives and friends about their experiences. Nearly all reported that medical professionals prescribed opioids after surgery and most said they were given big bottles to take home ‒ "a 90-day supply," said one, looking worried.

The national epidemic numbers are scary:

• 91 deaths from opioid overdose and addiction every day, according to the federal Centers for Disease Control and Prevention.
• 33,000 opioid-related deaths in 2015, again according to the CDC. Around 40 percent of all opioid overdose deaths involved drugs obtained by prescription, according to the Drug Enforcement Administration.
• Since 2015, drug overdoses have become the leading cause of death of Americans under 50, with two-thirds of those due to opioid misuse, again according to the DEA. In 2016, 64,000 Americans died from drug overdose, up astronomically from 16,000 in 2010.
• Opioids represent a diverse class of painkillers, including oxycodone, hydrocodone, and fentanyl, a drug synthesized to resemble heroin and morphine.
• Over the past decade, their use has increased significantly, in part because the medical profession has recognized that experiencing pain is an important symptom of ill health and is a legitimate area for medical treatment.

That often means opioids.

But the distressing fact remains that much standard medical practice is to prescribe opioids after surgery. So it's important news that a group of doctors at the University of Michigan have started a group aiming to cut in half the amount of opioids prescribed by surgical patients and those patients who still use them many months after surgery.

Called Michigan-OPEN (Opioid Prescribing Engagement Network), the idea is to provide research to help improve medical practice and surgical care.

"Surgeons prescribe a good percentage of opioid painkillers in Michigan, so we hope to guide them on the best use of drugs by patients before and after surgery," said Dr. Chad Brummett, a Michigan-OPEN leader and director of the Division of Pain Research at the U-M Medical School.

One big focus is on Medicaid, which is paid for by state and federal funds. Medicaid patients have 12 percent of all Michigan surgeries, but account for around 30 percent of people who become dependent on opioids afterward.

The Michigan-OPEN effort also aims at disposal of once-prescribed opioids ‒ like the Oxycontin I was given. A "take-back" event was held in Ann Arbor last month at Pioneer High School. Nearly 90,000 pills were collected and safely disposed of! The U-M group has held three such events around the state, collecting hundreds of pounds of pills.

Families interested in safe guidelines for disposal can find them here.

Anybody with direct experience with a family member or friend who is a doctor has some idea of how difficult it is to change long-established medical practice.

But the U-M Medical School and the Institute for Healthcare Policy and Innovation are not interested in hassling physicians; they're interested in working with them to make concrete change at the individual level.

Their approach is good news that the medical profession is now thinking seriously and taking action to deal with this devastating epidemic.

They deserve every success.

Readers interested in learning more should contact www.michigan-OPEN.org