Introduction
The opioid epidemic continues to be a critical public health issue, significantly impacting both the medical community and society at large. In particular, the role of opioid prescriptions following orthopaedic surgeries has been scrutinized due to its contribution to opioid misuse and addiction. The recent study titled "Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership" provides valuable insights into current prescribing practices and highlights areas for improvement. This blog aims to guide practitioners on how to implement the findings from this research to enhance their opioid prescribing practices and encourage further research in this vital area.
Key Findings from the Study
The study surveyed 191 Canadian orthopaedic surgeons and trainees, revealing significant variations in opioid-prescribing practices following open reduction internal fixation (ORIF) of distal radius and ankle fractures. Key findings include:
- Most respondents prescribed 10-40 tabs of immediate-release opioids, though the exact number varied considerably.
- 73.6% of respondents believed patients consumed only 40-80% of the prescribed opioids.
- Only 28.7% of respondents counselled patients on safe storage and disposal of leftover opioids.
- 30.5% of respondents felt confident in their knowledge of opioid use and mechanisms of addiction.
- Most respondents desired further education on opioid-prescribing protocols, alternative pain management strategies, and mechanisms of opioid addiction.
Implementing Research Findings into Practice
To improve opioid prescribing practices and mitigate the risks associated with opioid misuse, practitioners can implement the following strategies based on the study's findings:
1. Standardize Opioid Prescribing Protocols
The study highlights the lack of a standardized approach to opioid prescribing. Developing and adhering to standardized opioid-prescribing guidelines for common orthopaedic procedures can help reduce variations and prevent overprescription. These guidelines should be evidence-based and tailored to specific procedures to ensure optimal pain management while minimizing the risk of opioid misuse.
2. Educate Patients on Safe Opioid Use
Given that only a small percentage of respondents counselled patients on safe storage and disposal of leftover opioids, there is a clear need for improved patient education. Practitioners should routinely provide information on the importance of safe storage and proper disposal of unused opioids to prevent diversion and misuse. This can be achieved through verbal counselling, written materials, and follow-up consultations.
3. Enhance Multimodal Pain Management
Incorporating multimodal pain management strategies can reduce the reliance on opioids for postoperative pain control. The study found that many respondents already use adjuncts such as Tylenol, local anesthetic infiltration, and regional nerve blocks. Expanding the use of these and other non-opioid analgesics can further decrease opioid consumption and improve patient outcomes.
4. Provide Continuing Education for Practitioners
With only 30.5% of respondents feeling confident in their knowledge of opioid use and addiction mechanisms, there is a significant opportunity for continuing education. Practitioners should seek out and participate in educational programs focused on safe opioid-prescribing practices, alternative pain management strategies, and the latest research on opioid addiction. This will enhance their ability to prescribe opioids responsibly and effectively manage postoperative pain.
5. Screen for Substance Use Disorders
Routine screening for substance use disorders can help identify patients at higher risk of opioid misuse. The study found that 52% of respondents routinely screened new patients for substance use disorders and adjusted their prescribing practices accordingly. Implementing routine screening protocols and collaborating with addiction specialists can ensure that high-risk patients receive appropriate care and monitoring.
Encouraging Further Research
The study underscores the need for ongoing research to better understand and improve opioid-prescribing practices in orthopaedic surgery. Practitioners are encouraged to participate in and support research initiatives that aim to develop and validate standardized opioid-prescribing protocols, explore alternative pain management strategies, and investigate the long-term outcomes of different pain management approaches.
Conclusion
By implementing the findings from the study "Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures," practitioners can enhance their opioid-prescribing practices, reduce the risk of opioid misuse, and improve patient outcomes. Standardizing prescribing protocols, educating patients, enhancing multimodal pain management, providing continuing education, and screening for substance use disorders are key strategies to achieve these goals.
To read the original research paper, please follow this link: Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership.
