Advocacy News

March 15, 2016

IN THIS ISSUE

BACK TO MAIN

Annual Meeting Symposium: Payment Models in Orthopaedics

Governor Rick Perry Speaks at AAOS PAC Lunch

Task Force on Health Care Reform Releases Mission Statement

Precision Medicine Initiative Anniversary

Election 2016 Graphic of the Week

Senate Passes Opioid Bill

What We’re Reading

Annual Meeting Symposium: Opioid Strategies

2015 EHR “Meaningful Use” Hardship Exemption Information

AAOS Orthopaedic PAC Online Contribution Center

 
MORE RESOURCES

AAOS website

AAOS Calendar

House of Representatives Legislative Activities
   
Facebook Twitter

 

Annual Meeting Symposium: Opioid Strategies

On Wednesday, March 2, 2016, AAOS members at the Annual Meeting were invited to attend a symposium titled, “Risk Evaluation and Management Strategies for Prescribing Opioids.” The symposium was moderated by the former chair of the Medical Liability Committee, Thomas Fleeter, MD, and included three panelists. The discussion was centered on the epidemic of opioid drug use, misuse, and abuse in the United States and focused on ways in which orthopaedic surgeons can practice safe and effective pain management for their patients.

David H. Sohn, MD, JD opened the symposium with a discussion of the complicated legal landscape that has developed around physicians’ prescribing habits. In recent cases in different states, physicians have been found liable both for under-prescribing (typically in end-of-life situations) and for overprescribing pain medications. Furthermore, in 2015, the United States Drug Enforcement Agency (DEA) held its largest undercover operation in history, focused on opioids, which led to over 280 arrests. Dr. Sohn recommended that surgeons have standardized practices to document a sufficient physical exam, that they do not prescribe over the phone, and that they prescribe only per protocol. Additionally, he recommended having a standardized practice to document that the physician talked with the patient about the risks of opioid use and dependency and also to avoid driving or operating heavy machinery while using narcotics.

David Ring, MD, PhD, chair of the AAOS Patient Safety Committee, continued the symposium with a discussion on how to achieve pain relief without relying too strongly on pain medications. Dr. Ring noted that there are reasons why we have tended to prescribe substantial opioids: genuine care about a suffering patient, time pressure on visits, patient satisfaction pressures, and lack of reimbursement for treatment and evaluation of addiction. He also presented data demonstrating that most of the world has satisfactory pain relief using minimal opioids and that in the United States, patients that take more opioids experience worse pain relief. Dr. Ring recommended that physicians practice empathy and effective communication strategies, agree on an office strategy in order depersonalize conflicts about opioids, and consider psychosocial screening for patients choosing discretionary procedures, and discuss and plan pain relief.

On a broader level, Dr. Ring noted the need for a national, centralized, and automatic drug monitoring program, well-developed consensus standards, public education, access to data, and funding for studies on safe pain relief, behavioral health, and addiction.

Paul Arnstein, PhD, RN was the final panelist to speak. Dr. Arnstein discussed the benefits of pain relief with in order to reduce cardiovascular, respiratory, and neuro-endocrine morbidity that may delay recovery and prolong inpatient care. Dr. Arnstein also noted that CDC Guidelines and recent legislative initiatives should help curtail opioid overprescribing.