AAOS Issues Statement on Opioids in Orthopaedics

The current prescription-opioid/heroin epidemic in the US has been much publicized of late. According to a recent AAOS information statement, the nearly 100-percent increase in the number of narcotic pain-medication prescriptions between 2008 and 2011 corresponds to an increase in opioid diversion to nonmedical users as well as a resurgence in heroin use.

Among the strategies the AAOS statement calls for to stem the tide of opioid abuse and manage patient pain more safely and effectively are the following:

• Opioid-prescription policies at the practice level that
  • set ranges for acceptable amounts and durations of opioids for various musculoskeletal conditions,
  • limit opioid prescription sizes to only the amount of medication expected to be used,
  • strictly limit prescriptions for extended-release opioids, and
  • restrict opioid prescriptions for nonsurgical patients with chronic degenerative conditions.
• Tools (such as the opioid risk tool at MDCalc) that identify patients at risk for greater opioid use.
• Empathic communication with patients, who “use fewer opiates when they know their doctor cares about them as individuals,” according to the statement.
• An interstate tracking system that would allow surgeons and pharmacists to see all prescriptions filled in all states by a single patient.
• CME standards that require periodic physician CME on opioid safety and optimal pain management strategies.

Noting that stress, depression, and ineffective coping strategies tend to intensify a person’s experience of pain, the statement concludes that “peace of mind is the strongest pain reliever.”