AAOS Taking on Opioid Epidemic

The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors is confronting the problem of opioid abuse, with a new information statement outlining ways to improve physician, caregiver and patient education and track opioid prescription use, among other things.

“While minimizing patient discomfort remains an important goal of orthopaedic care, great caution should be used in prescribing opioids, ” said David Ring, M.D., Ph.D., a member of the AAOS Patient Safety Committee. “The new ‘AAOS Information Statement on Opioid Use, Misuse and Abuse in Orthopaedic Practice’ outlines specific strategies, considerations and collaborations for advancing safer and more effective pain management.”

“A culture change has created the current opioid epidemic, and only a culture change—led by physicians unafraid to limit opioid prescriptions—will solve the epidemic, ” said Dr. Ring.

Asked about stumbling blocks for orthopedic surgeons when it comes to discussing this issue with their patients, Dr. Ring told OTW, “Patients and surgeons tend to expect pain relief to come from pills. Both may be surprised when strong opioids don’t relieve pain as well as hoped. Most people know someone who has gotten hooked on opioids and many of us know someone who has died. The current opioid crisis makes it easy to discuss the limited role that opioids should play in pain relief. Just planning for pain management can make a huge difference in post-operative pain intensity. Surgery hurts. Pain after surgery, while expected, can feel like something’s wrong. When it feels like something is wrong, pain is amplified. Planning for these feelings, and devising a strategy for how to address pain with acetaminophen, non-steroidal anti-inflammatory drugs, ice, elevation, and splinting can go a long way. Being available to address patient concerns and empathize with their discomfort and unease is soothing. It can help to call patients the day after outpatient surgery. It can be difficult to say the right thing when someone is in pain. Surgeons are goal-oriented. We are technically oriented. And we aren’t always great communicators. Effective communication skills and empathy are key. Surgeons should script and practice their words for difficult situations. We should train ourselves to be more empathetic. Patients want to know that we take interest in them and care about them.”

“The nation is working hard on all fronts to correct the mistakes we made with opioids. No one argues the role of opioids in end of life care. But scientific evidence has established the limited benefit of opioids for both acute and persistent pain, and the substantial risks and real harms. The next step is to change the culture. We fear pain, but we should fear opioids equally and handle them with great respect and care. The evidence that our efforts are making a difference is in the statistics that show a decline in prescription opioid sales and the corresponding decline in opioid related deaths. We can prevent new addictions, but we need to take care of the people that are already hooked, many of whom are turning to heroin. I know we are making a difference when I partner with my patients to use as few opioids as possible and to put any leftover opioids in appropriate disposal units in policy stations and some health care facilities. People are aware of the problem and they want to help. I wish our national pharmacies would place these units in every store.”

Read the full information statement here.