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Overprescribing opioids

There is news almost every day about the epidemic of opioid drug use in the United States. Some 65 percent of heroin users report that they used prescription opioids first and then made the switch to heroin. And current estimates are that 4-20 percent of all opioid pills prescribed in the United States actually are taken for nonmedical reasons. Now, an anesthesiologist and a surgeon at Washington University School of Medicine in St. Louis are proposing ways to reduce the availability of opioid drugs by eliminating some of them from the pipeline. Among other things, they’re proposing that doctors prescribe fewer pills for patients after they undergo surgery and that pharmaceutical companies initiate turn-in programs for unused opioids.

THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION IS RECOMMENDING THAT DOCTORS TRY TO AVOID PRESCRIBING OPIOID PAINKILLERS FOR MANY PATIENTS, AND NOW EXPERTS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS ARE RECOMMENDING IN THE JOURNAL ANESTHESIOLOGY THAT PHYSICIANS ALSO MAY WANT TO CUT BACK ON OVER-PRESCRIBING TAKE-HOME OPIOID DRUGS FOR SURGERY PATIENTS. THEY HOPE TO LIMIT THE RESERVOIR OF UNUSED PAINKILLERS IN THE COMMUNITY. JIM DRYDEN HAS THE STORY…

MORE THAN 80 PERCENT OF ALL OF THE OPIOID PRESCRIPTIONS IN THE WORLD ARE WRITTEN BY DOCTORS IN THE UNITED STATES, AND NOT ALL OF THOSE DRUGS ARE TAKEN TO TREAT PAIN. THE PROBLEM OF OPIOID PAINKILLER ABUSE HAS BEEN GETTING A LOT OF ATTENTION LATELY, BUT WASHINGTON UNIVERSITY ANESTESIOLOGIST EVAN KHARASCH SAYS MOST OF US DON’T APPRECIATE JUST HOW BIG THE PROBLEM IS.

(act) :14 o/c opioid overdose

There is an accidental opioid overdose in this country every 18

minutes. More than 28,000 people last year died from an accidental

opioid overdose.

THAT NUMBER INCLUDES BOTH PRESCRIPTION OPIOIDS AND HEROIN. RESEARCH OVER THE LAST FEW YEARS HAS FOUND THAT MANY PEOPLE START GETTING HIGH ON PRESCRIPTION DRUGS AND THEN MOVE ON TO HEROIN BECAUSE IT’S CHEAPER. KHARASCH SAYS SURGERY PATIENTS OFTEN TAKE HOME PRESCRIPTIONS FOR PAINKILLERS, BUT THEN THEY DON’T NEED ALL OF THE PILLS.

(act) :21 o/c or taken

There is a reservoir of unused opioids in the community.

Many people may get an opioid prescription. They may not

take all the opioids, and the remaining drugs sit in their

medicine cabinet. What we’ve now come to learn is that

sometimes those opioids are diverted or taken.

ONE POTENTIAL SOLUTION, HE SAYS, WOULD BE TO SEND PATIENTS HOME AFTER SURGERY WITH FEWER PILLS. INSTEAD OF A BIG PRESCRIPTION, HE SAYS SURGEONS AND ANESTHESIOLOGISTS COULD PRESCRIBE FEWER PILLS AND THEN REFILL THE PRESCRIPTIONS AS NEEDED TO MAKE SURE PAIN NEEDS ARE ADEQUATELY ADDRESSED, WITHOUT OVERPRESCRIBING.

(act) :15 o/c pain pills

It is not unusual for patients to be sent home with 30, 60,

90 pills, and they may only take them for two or three days.

One approach to the problem is to simply prescribe fewer

pain pills.

ANOTHER WAY TO REDUCE THE NUMBER OF POTENTIALLY DANGEROUS OPIOIDS SITTING IN MEDICINE CABINETS WOULD BE TO ALLOW PEOPLE TO RETURN DRUGS THEY WON’T BE NEEDING.

(act) :14 o/c under-appreciated

There are some pharmacies which may take unused opioids back,

in return, to get the unused drugs out of the house and get them

away from misuse. That’s an avenue which is under-utilized and

under-appreciated.

AND KHARASCH SAYS ONE MORE POTENTIAL STRATEGY INVOLVES THE WAY THAT DOCTORS EMPLOY OPIOID DRUGS WHILE SURGERY PATIENTS ARE IN THE HOSPITAL. HE SAYS IN RECENT YEARS THERE HAS BEEN A MOVEMENT TO USE SHORTER-ACTING PAINKILLERS IN THOSE PATIENTS.

(act) :17 o/c home with

Should we, instead of using short-duration opioids, should we

be using long-duration opioids in surgery so that patients are

more comfortable for a longer period of time, and they may need

fewer pain pills to go home with?

KHARASCH SAYS SOMETHING HAS TO BE DONE TO PREVENT OVERDOSES AND ADDICTION. IT’S ESTIMATED THAT ABOUT 5 MILLION AMERICANS USE PRESCIPTION OPIOIDS FOR NON-MEDICAL REASONS, AND THE COST TO THE U.S. ECONOMY IS ESTIMATED TO BE ABOUT $70 BILLION DOLLARS PER YEAR. I’M JIM DRYDEN…

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