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URMC / Department of Surgery / Opt-in Program for Narcotics

 

Opt-in Program for Narcotics

Jacob Moalem, Dept. of Surgery Team Tests Opt-in
Program for Narcotics

opioidEmpowering patients to decide whether or not to receive narcotics for pain control following cervical endocrine surgery led to a 96.6 percent reduction in the number of narcotic tablets prescribed, according to a new study published in Annals of Surgery.

A team led by Jacob Moalem, M.D., associate professor in the department of Surgery, designed an “opt-in” prescription system for patients undergoing ambulatory procedures such as thyroidectomy and parathyroidectomy. They hypothesized that many patients, if given adequate education, non-narcotic analgesia and the prerogative to choose would decline narcotic prescriptions for discharge.

A total of 216 patients scheduled for outpatient cervical endocrine surgery between July 2017 and June 2018 participated in the narcotic opt-in program. The team found:  

  • Only nine patients (4 percent) requested prescription narcotic medication at discharge and no patient called after discharge to request analgesic medications.
  • Compared with their prior treatment paradigm, the opt-in program resulted in a 96.6 percent reduction in the number of narcotic tablets prescribed and a 98 percent reduction in unconsumed tablets.
  • Over the course of the year, the initiative resulted in 4,175 fewer tablets in circulation in the community.
  • Longer incisions and prior substance abuse predicted higher likelihood of requesting pain medication on discharge.

“All providers have a shared responsibility to lessen the impact of the opioid epidemic, and surgeons in particular can play a role in reducing the availability of narcotics,” said Moalem, director of quality and safety for the department of Surgery. “Getting a program like this up-and-running doesn’t require a large amount of resources other than educating staff and patients, and we believe our model can be used in other surgical specialties here at the University of Rochester and nationally.”

Under his leadership, the department is forming interdisciplinary groups to identify other high-volume procedures where patients can go home with minimal or no narcotics, such as gall bladder removal and robotic hernia repair.  Moalem is also collaborating with colleagues at leading hospitals across the country to implement similar programs at their institutions.

The effort began in 2014 when the team started collecting data on pain medication utilization by patients as part of a multi-institutional study. A subsequent analysis of the endocrine surgery program’s data revealed that 41 percent of patients took no narcotics following discharge. The finding led to the current study, where the default method of postoperative pain control was non-narcotic.

“Our approach is unique in that we partnered with patients to achieve a substantial reduction, and in most cases, elimination of prescribed narcotics,” noted Luis Ruffolo, M.D., a research resident in the department of Surgery. “In many cases, medical research is conducted without the input of patients because we assume that they don’t have the medical background to make informed decisions. But when it comes to pain, the exact thing we’re treating is the patient’s perception of the event.”

To the team’s knowledge, no other group has demonstrated that allowing patients to decide if they need narcotics for discharge can result in a substantial number of patients opting not to receive any of these medicines.

Ruffolo and Moalem say the study is the result of a terrific group effort, with important contributions by residents, medical students and advanced practice providers. Other study authors include Katherine Jackson, M.D.; Peter Juviler, M.D.; Roma Kaur, M.D.; Todd Chennell, NP-C; Danielle Glover, PA; and David Linehan, M.D.

Linehan, the Seymour I. Schwartz Professor and Chair of the department of Surgery, says this study is part of a multi-pronged approach that his department is taking to limit the number of narcotics that end up in medicine cabinets in our community. Other initiatives include enhanced recovery programs where long-acting spinal anesthetics are given post-surgery to lessen the use of narcotics, and prescription drug take-back days organized by the department to collect unused medications.

Published on October 04, 2019