How spine surgeons can combat the opioid epidemic – key thoughts from 4 surgeons

Written by Alan Condon | July 01, 2019 | Print  |

The national opioid epidemic is one of the most pressing issues facing healthcare in the United States. Four spine and neurosurgeons provide their insight on how to tackle the opioid epidemic.

Question: Have you any thoughts on how to tackle the current opioid epidemic?

Dr. Zeeshan Sardar, MD. NewYork-Presbyterian Och Spine Hospital in New York City: We need participation from everyone to tackle a problem as complex as the current opioid epidemic. The responsibility must be shared by physicians, patients, researchers, pharmaceutical companies, legislators and even the general public. Most acute pain conditions do not require opioid medications or require a very short duration of these medications. 

As physicians, our role should be to appropriately diagnose and treat the patient while understanding the risks of prescribing opioid medications. Taking the time to listen to the patient and examine the patient and carry out the right investigations can help significantly in finding the cause of the pain. Once the cause of the pain is identified we can perform targeted treatment to address the problem instead of using opioid medications to mask the pain. I also focus a lot on multimodal pain management in my practice to address the pain from different perspectives and maximize the improvement potential. While most patients do not require surgery, a select group of patients can greatly benefit from surgical treatment to address the pain generator and avoid dependence on opioids.

However, opioid treatment is still an important tool in the management of pain in patients with cancer, patients requiring palliative care, and patients with other significant chronic pain conditions.

Todd Chapman, MD. OrthoCarolina Spine Center (Charlotte, N.C.): The current opioid epidemic is multifaceted in terms of reasons that it exists, and the approaches needed to address it should be multifaceted as well. Pain is certainly something that should be addressed, and narcotic addiction is a risk of opioid medication. Opioid use in our country is a profound problem and finding a balance is important. Some patients truly do benefit from the analgesic properties that allow them to live productive, meaningful lives. But because there is such a strong trend currently against narcotics, in the name of stemming the epidemic we also limit access for those patients who need them and use them appropriately.

Education and time spent with patients discussing expectations is a front line therapy that many of us as providers could dedicate more time to. Setting expectations that pain associated with surgery and orthopedic conditions is temporary is important. Utilizing other non-opioid medications to address the pain associated with injury and surgery is a parallel strategy we should continue exploring and implementing aggressively. 

Andrew Freese, MD. Suburban Community Hospital (East Norriton Township, Pa.): I think the current opioid epidemic is multifactorial and holding physicians responsible for controlling it is naïve. There are unscrupulous doctors, just as there are unscrupulous members of any profession, who have abused their privilege to write narcotic prescriptions, but that does not mean the overwhelming plurality of doctors are guilty. Pain remains a major problem in our society, particularly as technology advances and keeps people alive longer and longer, with illnesses associated with aging that cause pain (fractures, osteopenia/porosis, osteoarthritis, spine degeneration, etc.). Appropriate pain medication remains a legitimate way of helping these patients.  

Tackling the opiate crisis includes: 1) reducing the supply — just this week at a port in Philadelphia (where I now live) there was a $1 billion dollar raid of narcotics from Latin America, 2) reducing the demand — understanding why so many people in the USA turn to drugs to self-medicate for depression, hopelessness, poverty, addiction and others, 3) reducing excess use of legal narcotics by identifying where in the supply chain there is an excess, 4) stopping all advertising, 5) research into non-addictive alternatives, 6) education of all stakeholders, 7) providing family and spiritual support to reduce the desire and use of narcotics, and many others. No one group of individuals is responsible, and doctors should not be the scapegoat.

Harel Deutsch, MD. Rush University (Chicago): It takes a cultural change. Medical societies and society were pressing doctors to treat pain with narcotics. Doctors were reluctant for the most part but because of patient demand, many patients were on long-term narcotics for chronic pain complaints. Now there is more cover for doctors to refuse to prescribe narcotics. I’ve seen a dramatic reduction in the number of patients coming in on long-term narcotics.

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