Opioids in Orthopaedic Practice

The vast majority of opioid prescriptions written by orthopedic surgeons are to control post-operative or traumatic pain in the acute setting - situations where pain is expected due to the abrupt change in a patient (e.g. fracture, knee replacement, etc). POS recognizes, however, that orthopaedic surgeons need to take measures to help minimize opioid medication overuse and to seek and to implement alternative pain management modalities at the outset of acute pain developing.

A change in the cultural expectations surrounding acute and chronic musculoskeletal pain management is needed also. Orthopaedic surgeons across the country regularly perform procedures that improve our patients' lives. Patients need to understand, however, that some degree of pain during recovery is unavoidable.  Likewise, physicians need to better communicate to patients the dangers of opioid use in the recovery process.  POS encourages all physicians to engage in conversations with their patients regarding realistic expectations of pain control and the risks associated with opioid medications. 

POS has partnered with other healthcare organization members within the Commonwealth to create workable solutions to this complex problem in the acute setting.  The POS Board of Directors recently adopted Opioid Recommendations for Acute Pain for use by our members and other physicians. In addition, post-operative medication expectations should be discussed with patients to avoid misunderstandings.

To learn more about the opioid crisis, visit AAOS. You can also earn CME through the AAOS webinar, Risk Evaluation and Management Strategies for Prescribing Opioids (login required).

Here's what PA orthopedists are doing to fight opioid abuse (op-ed by POS Vice President, Patrick Smith, MD featured on PennLive May 3, 2016).

Surgery and Opioids - Pennsylvania Health News Service Project 

As part of the commonwealth’s active role in combatting the opioid epidemic, the Pennsylvania Department of Health (DOH) is introducing the Pennsylvania Prescription Drug Monitoring Program (PA PDMP.) The PA PDMP will provide prescribers and dispensers an additional resource for making informed clinical decisions by providing patients’ schedule II - V prescription history.

Prescribers (or their delegates) are required to check the PDMP system the first time they are prescribing a controlled substance for a patient, or when there is clinical concern the patient is suffering from the disease of addiction or is diverting a controlled substance(s).  However, as a best clinical practice, the DOH recommends prescribers and dispensers check the system every time. 

For more information including tutorials, FAQs and more, and to register, please visit 
www.doh.pa.gov/PDMP.​

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