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The Role of Anesthesiologists in Treating Substance Abuse Patients

Becker's Hospital Review

Originally published in Becker's Hospital Review on October 15, 2018 – written by John C. Dalton, MD, Chief Quality Officer of PhyMed.

Using non-narcotic pain relief throughout the perioperative process

According to the latest data from the CDC, more than 174 Americans die each day from drug overdose. Of those deaths, 67 percent are opioid-related,1 and deaths from heroin alone have risen 533 percent since 2002.2 Since heroin is typically injected, this also increases the risk of HIV and hepatitis.3 The devastating consequences of the opioid epidemic, including opioid misuse, abuse, incarceration, overdose and newborns experiencing withdrawal syndrome, cannot be overstated. These problems can negatively impact families for generations.

The challenges of opioid dependence and addiction throughout the perioperative process

Sometimes, emergency or urgent surgery may often require that care proceed without full knowledge of a patient’s medical history. Patients having elective surgery may either be known or unknown chronic opioid users or on medication-assisted treatment for dependence. For those patients in recovery from addiction, surgery and pain management with opioids may trigger a relapse. These are complex concerns since the majority of patients will require pain medication at some point in the perioperative or post-discharge period. Without readily available current and accurate health history data, these patients may be inadvertently put at risk for relapse, undertreatment of pain, and overdose.

To complicate matters further, patient satisfaction scores for pain relief also impact reimbursement. Hospitals and physicians are required to report patient satisfaction scores as part of the Merit-Based Incentive Payment System (MIPS), a government program tied to provider reimbursements. Because of this, hospitals and physicians may feel financial pressure to respond liberally to a patient’s request for opioids in an effort to not only reduce pain, but to increase patient satisfaction scores to protect the hospital’s bottom line.

Comfortable patients enjoy shorter stays in the hospital, and recover faster with fewer complications. The pursuit of higher patient satisfaction scores through reliance on opioids can paradoxically delay return to normal life at an enormous cost, not only in patient convenience, expense and discomfort but can predispose patients to undertreatment of pain, abuse, addiction, relapse and overdose. And sadly, we know that patients who relapse are at higher risk for overdose and death.

True value-based care means returning patients to their lives at the lowest overall cost in terms of convenience, expense and discomfort.

An innovative approach to pain control in substance abuse patients

But there are alternatives. The anesthesia care team can play an active role in effectively managing the complexity of perioperative pain by implementing innovative pain management programs. Some of these teams are using non-narcotic pain relief systems designed to deliver local anesthetic at or near the surgical site through specially designed catheters. Not only does this system provide patients days of targeted pain relief after surgery, it also delivers:

  • Better pain relief, while reducing narcotic side effects, such as: nausea, vomiting, constipation and grogginess
  • Less need for narcotics
  • A quicker return to normal body function
  • Feeling better faster
  • Greater mobility
  • Potential for earlier hospital release

Non-narcotic pain relief systems, “single shot” nerve blocks and multimodal analgesic regimens all fit together in a collaborative approach to improving pain control while lessening the adverse effects of opioids.

Collaboration and communication are key to success

Anesthesiologists and CRNAs must work as part of the hospital team to provide patients and their families with the best tools and resources to effectively treat pain levels throughout the perioperative process, while reducing negative outcomes in substance abuse patients.

Sources:
1 https://www.addictionpolicy.org/blog/174-a-day-understanding-the-numbers
2 https://www.cnn.com/2017/09/08/health/heroin-deaths-samhsa-report/index.html
3 http://www.who.int/substance_abuse/facts/opiates/en/

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