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Opioids and practice: Getting it RIGHTT

Brian K. Yorkgitis, PA-C, DO

The growing opioid epidemic increases pressure on the healthcare community to tackle this issue. The rate of opioid-related deaths has increased over time. The CDC estimated more
than 33,000 deaths in 2015% were attributed to opioids. Included in this number is deaths caused by prescription medications, which was estimated at close to 22,500 in 2015.1 In 2013, the NIH estimatedł million people suffered from substance use disorder related to prescription opioid pain medications, with the number only expected to rise. Each day, 1,000 people are treated in EDs for inappropriate prescription opioid use.2

No one chooses to become part of this statistic; they have a disease. As clinicians, we must focus on how we can help patients through prevention and treatment. We must think carefully each time we prescribe an opioid. Every time I approach a patient in pain, I hope to get it RIGHTT…

Risk for adverse eventLook for patient risk factors for opioid abuse or misuse (use the opioid risk tool developed by Webster).3 Use your state’s prescription drug monitoring program if available.

Insight in to painâ€Set functional goals for pain relief rather than a number. Most of the time, you can’t make patients pain-free so the goal is to keep them functional.


G
oing over pain planDiscuss with your patient a stepwise approach to analgesia. Use nonopioids first, such as NSAIDs, acetaminophen, gabapentin, or pregabalin. If opioids are needed, use them in conjunction with nonopioid adjuncts to allow the minimal dose of opioid possible.

Halting opioids—Opioid duration should be as short as possible. Communicate with your patient the duration that you would expect a patient with that condition to require opioids. Advise them that longer durations are associated with increased risk of dependence.

Throwing away unused medications—Discuss methods to dispose of unused opioids to prevent diversion (local drop-off locations, mixing unused pills in kitchen waste or cat litter).


T
rouble—If you feel your patient is developing trouble with opioids, offer assistance instead of chastising.

Be a
PArtner in this growing problem through these simple steps. Invest the time in getting it RIGHTT; the return on your investment could be lifesaving.

REFERENCES
1. National Institutes of Health, National Institute on Drug Abuse. Overdose death rates. 

2. Centers for Disease Control and Prevention. Prescription opioid overdose data.

3. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the opioid risk tool.
Pain Med. 2005;6(6):432-442.


Brian K. Yorkgitis practices in the Division of Acute Care Surgery at the University of Florida-Jacksonville. The views expressed in this blog post are those of the author and may not reflect AAPA policies.

Published: 7/24/2017 1ᛖ:00 PM

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