With the opioid crisis still rampaging communities in the Midwest, doctors are beginning to reevaluate their prescription of these addictive medicines. Michigan Medicine doctor Ryan Howard pioneered a study analyzing doctors’ prescription of opioids following surgery. The statewide study of Michigan found surgical patients typically take only a quarter of the opioid pills prescribed.
“We collected data about opioid prescribing and how many pills patients took over about a dozen surgeries (at hospitals) all over the state … How much do we prescribe, how much are they taking, are we prescribing the right amount,” Howard said. “It was kind of eye-opening to see this not only at a single institution, but at hospitals all over the place.”
Howard said many factors are associated with how many pills patients take: type of surgery, mental health and pre-existing conditions. However, the study found doctors prescribing nearly 70 different opioid pills such as Vicodin, Percocet or Oxycontin for relatively minor or less invasive surgeries.
“What was really shocking was the strongest association of how many pills people take depends on how many we prescribe them,” Howard said. “The factor in them taking more pills is just them getting a prescription.”
Howard’s study highlights the larger problem of overprescribing pills, which increases the amount of opioids in the community, fueling the addiction epidemic.
“(The study) demonstrates that overprescribing is a really big problem,” Howard said. “The prescriptions we write are integrally related to how much medicine patients take and (doctors) have to take ownership of that to keep patients and communities safe.”
The purpose of the study is to create a solution to the problem of overprescribing, Howard explained. According to Howard, Michigan has a state regulation restricting the prescription of opioids over a certain time period. He views these general regulations as the government's “quick and easy” way to limit opioids in communities.
“I’m not so sure that blanket regulations are the solution to the problem,” Howard said. “The solution is doing studies like these that are more specific to patients. The reason we are doing it like this is to create a solution that is patient-centered and physician driven.”
Through this study, the team created opioid recommendation guidelines for 20 common surgical procedures. Howard’s next steps are looking at patient predictors to see how much to prescribe in order to customize the amount of medication they need.
Surgical resident Joceline Vu, a senior author on the study, worked with Howard to design the study and analyze the data. Vu said the study fits into the bigger picture of the addiction epidemic. Vu said the more opioids prescribed after a surgery, the more opioids a patient will take.
“We confirmed that, yes, surgeons are prescribing way too many pills, far more than people need after surgery,” Vu said. “They are taking a lot because we prescribe them a lot and they might not need them after all.”
Vu said doctors prescribe so many opioid pills for patients because of patient satisfaction and uncertainty as to how much they actually need. These habits over time have created a large excess supply of opioids.
“One of the reasons why we prescribe so much for patients after surgery is the customer service aspect and a fear that patients won’t be satisfied after surgery if they don’t have pain control,” Vu said. “We can safely cut down our prescribing and still be giving more than patients actually take, so if we reduce our prescribing we are not going to leave our patients with not enough medication.”
She hopes medical professionals will look at the data and feel comfortable prescribing fewer opioids knowing people may not need as much. According to Vu, Michigan’s regulation of opioids is necessary but not sufficient and will not be successful because doctors can still prescribe too many.
“I don’t necessarily think that regulation is the answer,” Vu said. “What I really hope is that this drives doctors and nurses to really change the way they prescribe from a provider-driven stance.”
Vu emphasized the danger of excess opioids in the community. She said leftover opioids from a procedure simply sitting in one’s cabinet can increase the risk of one becoming addicted or increase the possibility of someone breaking in to get the pills.
“Those pills stick around in your medicine cabinet and you’re more likely to become addicted to them or your kids might find them or someone might break into your house for them, so they continue to pose a danger … and fuel the opioid crisis,” Vu said. “We want our patients to take fewer opioids and the easiest way to do that is give them fewer.”
LSA sophomore Mia Feinbaum, a psychology student interested in addiction, said she sees the direct connection between the over-prescription of opioids and addiction.
“A lot of addictions to ‘street drugs’ start by the use of legally prescribed drugs,” Feinbaum said. “Health care providers, encouraged by large pharmaceutical companies, who prescribe these painkillers in great numbers hold a fairly large part of the blame for the opioid crisis.”
According to Feinbaum, the study confirms the responsibility of excess opioids on the healthcare industry.
“Pharmaceutical companies and healthcare providers need to take some responsibility for the effects of the widespread use of highly addictive medications,” Feinbaum said.