Opioid-related deaths are a leading national and community concern. Unfortunately, reports of opioid-related deaths occur with astonishing regularity in our daily news feeds.
“Though much of the attention on opioid-related harm is centred on the improper use of opioids in the community (misuse, diversion, etc.), the truth is that opioid harm exists across a continuum of care,” says Michael Wong, (founder and executive director, Physician-Patient Alliance for Health & Safety), “which begins with the safe use of opioid analgesics in the hospital setting and the prescription of opioids upon discharge of the patient from a healthcare facility. We must first and foremost make sure that opioids provided to patients are done so in a safe manner both during administration and upon discharge.”
5 KEY STEPS TO PRESCRIBING OPIOIDS:
- Recognise the critical role of physicians in the lives of patients and the impact that they can play in the opioid epidemic
- Answer the call by clinicians to provide them with the necessary tools and information they need to make informed and safe treatment recommendations
- Advocate for a more balanced approach by considering other pain management alternatives before immediately prescribing an opioid
- Monitor all patients receiving pain medications, and particularly opioids, to ensure that these patients are safe
- Make sure that patients understand physician-recommended treatments.
The attention given to the opioid epidemic has resulted in a negative-opioid prescribing environment. However, it must be remembered that there are some patients and medical procedures that require the use of opioids and that when this happens we need to make sure that these patients receiving opioids are adequately monitored to ensure their safety. The PPAHS recommends that all patients receiving opioids should be monitored with pulse oximetry for oxygenation and with capnography for adequacy of ventilation.
The recently pronounced guidelines from the American Association of Oral and Maxillo facial Surgeons (AAOMS) also set forth guidelines for managing a patient’s acute and postoperative pain. The AAOMS guidelines emphasise the need for a balanced approach to the prescribing of opioids and highlight:
“Prescribing ibuprofen, and/or possibly acetaminophen, as a first-line analgesic therapy for postoperative pain (rather than starting with opioids). Advising a long-acting local anaesthetic to delay onset and severity of postoperative pain. Carefully documenting instructions for patient pain management. Accessing state prescription drug monitoring programs as required. If necessary, using only short-acting opioids at the lowest dose possible for the shortest duration possible.”
The American Pain Society (APS) strongly recommends that clinicians continuously assess and monitor their patients receiving pain medication, particularly if it involves opioid administration:
- Conduct a preoperative evaluation, including assessment of medical and psychiatric comorbidities, concomitant medications, history of chronic pain, and substance abuse
- Adjust the pain management plan on the basis of adequacy of pain relief and presence of adverse events
- Use a validated pain assessment tool to track response to postoperative pain treatments and adjust treatment plans accordingly
- Appropriately monitor sedation, respiratory status, and other adverse events in patients who receive systemic opioids
- Provide appropriate monitoring of patients who have received neuraxial interventions for perioperative analgesia
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