U-M leading drive to cut opioids given after surgery

"Epidemic" is a tough word, and one often overused.

But it's now clear that we are now facing an enormous and relatively new public health epidemic from the overuse of and our growing addiction to opioid drugs.

And they aren’t all coming from back-alley pushers. Though the exact proportions are not clear, a significant percentage of opioids that enter the supply chain are prescribed by physicians, either to reduce postoperative pain or to help patients with mood disorders.

Research conducted by the University of Michigan further shows that about one-in-10 people who were not on opioid drugs before surgery became dependent on them.

Naturally, a lot of the stuff that does get into the black market comes from pharmacy “pill mills,” corrupt doctors and faked prescriptions and drug dealers. Maybe 35 percent of all prescriptions written are for "acute care" and involve postoperative pain relief, dentistry and emergency medicine ‒ long-accepted medical practice.

I should know. Back in 2010, I had both knees surgically replaced ‒ the result of years and years of tennis, squash, hiking, fly fishing, gardening. Just after my surgery, the nurse gave me two tablets of Oxycontin. "Take these," she said.

"They'll take away the pain."

You bet they did. They also made my brain feel like mashed potatoes. When the surgeon visited me that evening, I asked him to take me off that stuff. But when I was discharged from the hospital, I was given a bottle of 50 or so Oxycontin pills to take home.

I never used them.

Since then, I must have talked to 20 relatives and friends about their experiences. Nearly all reported that medical professionals prescribed opioids after surgery and most said they were given big bottles to take home ‒ "a 90-day supply," said one, looking worried.

The national epidemic numbers are scary:

  • 91 deaths from opioid overdose and addiction every day, according to the federal Centers for Disease Control and Prevention.
  • 33,000 opioid-related deaths in 2015, again according to the CDC. Around 40 percent of all opioid overdose deaths involved drugs obtained by prescription, according to the Drug Enforcement Administration.
  • Since 2015, drug overdoses have become the leading cause of death of Americans under 50, with two-thirds of those due to opioid misuse, again according to the DEA. In 2016, 64,000 Americans died from drug overdose, up astronomically from 16,000 in 2010.
  • Opioids represent a diverse class of painkillers, including oxycodone, hydrocodone, and fentanyl, a drug synthesized to resemble heroin and morphine.
  • Over the past decade, their use has increased significantly, in part because the medical profession has recognized that experiencing pain is an important symptom of ill health and is a legitimate area for medical treatment.

That often means opioids.

But the distressing fact remains that much standard medical practice is to prescribe opioids after surgery. So it's important news that a group of doctors at the University of Michigan have started a group aiming to cut in half the amount of opioids prescribed by surgical patients and those patients who still use them many months after surgery.

Called Michigan-OPEN (Opioid Prescribing Engagement Network), the idea is to provide research to help improve medical practice and surgical care.

"Surgeons prescribe a good percentage of opioid painkillers in Michigan, so we hope to guide them on the best use of drugs by patients before and after surgery," said Dr. Chad Brummett, a Michigan-OPEN leader and director of the Division of Pain Research at the U-M Medical School.

One big focus is on Medicaid, which is paid for by state and federal funds. Medicaid patients have 12 percent of all Michigan surgeries, but account for around 30 percent of people who become dependent on opioids afterward.

The Michigan-OPEN effort also aims at disposal of once-prescribed opioids ‒ like the Oxycontin I was given. A "take-back" event was held in Ann Arbor last month at Pioneer High School. Nearly 90,000 pills were collected and safely disposed of! The U-M group has held three such events around the state, collecting hundreds of pounds of pills.

Families interested in safe guidelines for disposal can find them here.

Anybody with direct experience with a family member or friend who is a doctor has some idea of how difficult it is to change long-established medical practice.

But the U-M Medical School and the Institute for Healthcare Policy and Innovation are not interested in hassling physicians; they're interested in working with them to make concrete change at the individual level.

Their approach is good news that the medical profession is now thinking seriously and taking action to deal with this devastating epidemic.

They deserve every success.

Readers interested in learning more should contact www.michigan-OPEN.org

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Comments

Rosalie
Tue, 11/07/2017 - 9:23am

What has happened to "nursing fundamentals" and using that knowledge to assist with keeping a patient comfortable without use of meds?

Brenda Ammon
Tue, 11/07/2017 - 10:51am

This information in this article is truth. Yes, corrective actions taken will limit exposure to
persons that never experienced pain medication before but that is an attempt to
control behavior. The root of the problem is why so many people have insecurities in
life that can so easily become dependent on a substance for relief of what is most usually
emotional pain and not physical?

The world lacks love. This stems from many causes. However, a radical mutation in how brains cells and insecurities that develop in life from being indoctrinated into the current education system can profoundly impact society.

Research clearly shows how schools kill curiosity and other harmful outcomes of being sorted, measured and compared against one another. Yet the experts continue to repeat this behavior because they can. Adults don't like being labeled, why should human beings support a system that has this division as it's very sustenance.

The education system would transform life if ALL children were viewed as creative geniuses. If it were instilled in them that they have the power within themselves to be entrepreneur learners. ALL children need to be shown emotional freedom from a broken system that defines their worth.

Emotional freedom is the significant piece missing in society.

Who wants a radical transformation in the hearts and minds of human beings? Not simply a focus on controlling exposure to drugs. A profound insight into humanity can only begin with a profound change in the context of how children and all humans are viewed.

Human beings are creative geniuses. You can't make that shit up! Yet, no one shows them. I give my life to let every human being realize this truth.

Experts say it's complex. They want it to be complex. It's not. It's simple.

Brenda Ammon
Brenyammon@gmail.com

Brenda Ammon
Tue, 11/07/2017 - 11:42am

This information in this article is truth. Yes, corrective actions taken will limit exposure to
persons that never experienced pain medication before but that is an attempt to
control behavior. The root of the problem is why so many people have insecurities in
life that can so easily become dependent on a substance for relief of what is most usually
emotional pain and not physical?

The world lacks love. This stems from many causes. However, a radical mutation in brains cells and insecurities that develop in life from being indoctrinated into the current education system can profoundly impact society.

Research clearly shows how schools kill curiosity and other harmful outcomes of being sorted, measured and compared against one another. Yet the experts continue to repeat this behavior because they can. Adults don't like being labeled, why should human beings support a system that has this division as its very sustenance.

The education system can be a catalyst to transform lives if ALL children were viewed as creative geniuses. If children and adults were shown that they have the power within themselves to be entrepreneur learners. Then all involved would have emotional freedom from a broken system that defines their worth.

Who wants a radical transformation in the hearts and minds of human beings? Not simply a focus on controlling exposure to drugs. A profound insight into humanity can only begin with a radical revolution in the context of how children and all humans are viewed.

Human beings are creative geniuses. You can't make that shit up! Yet, no one shows them.
I give my life to let every human being realize this truth.

Experts say it's complex. Yet, the solution is incredibly simple. It’s just really, really, really painful and difficult to endure. And so most people avoid setting aside their intellectual knowledge for a shift in context.

Brenda Ammon
Brenyammon@gmail.com

Michigan Observer
Wed, 11/08/2017 - 6:32pm

"The world lacks love. This stems from many causes. However, a radical mutation in brains cells and insecurities that develop in life from being indoctrinated into the current education system can profoundly impact society."

Will someone slowly and carefully explain what this means? I have read it four times and still don't have a clue.

"Research clearly shows how schools kill curiosity and other harmful outcomes of being sorted, measured and compared against one another." Does she mean to say that people should not be known? Should not be perceived? We should not make a judgment that a particular individual is not qualified to perform a critical task, whereas another individual is eminently qualified? Is that what she is saying?

Brenda Ammon
Thu, 11/09/2017 - 8:39am

There is immense suffering in the world. Is it practical the way human beings live? A shooting killing 26 in Texas and a bomb exploding and killing people in New York all in one week. This is the society that human beings have been a part of creating.

To have a radical shift in what it means to be a human being it must start with the education system that children are indoctrinated into. The current system sorts, measures and defines their worth at a very early age. Is this necessary as a way of learning. This system sets up a hierarchy that compares one individual to another. The strong that can conform survive, the weak fail. The current education system leaves destruction in its path.

Yale Law school does not fail anyone. How incredible would it be for the creative geniuses that all children are to be a part of an educational system that sees their worthiness and has no reason to fail them. Why can this only happen in an elite law school?

How different would children respond if they were shown how to get comfortable with failure when they were young. It would change their lives. They would no longer take on failure as an identity when they fail. They would be empowered to see that failure is an integral part of the learning process. That human beings don't grow up having the right answers and even as an adult you don't have the right answers, (anyone want to have the courage to be vulnerable and admit that??) so why should the focus be on having the right answers in school or you fail.

The content of education is one thing. The learning about life is completely different. If the latter is not contemplated in the education system, great suffering will continue to be the norm and not the exception.

Brenda Ammon
brenyammon@gmail.com

Michigan Observer
Thu, 11/09/2017 - 7:31pm

Ms. Ammon correctly says, "How different would children respond if they were shown how to get comfortable with failure when they were young. It would change their lives. They would no longer take on failure as an identity when they fail. They would be empowered to see that failure is an integral part of the learning process. ". But then she goes on to object when people are informed that they have failed. If failure is a normal, healthy part of the learning process, why does she object to it?

Anonymous
Fri, 11/10/2017 - 12:54pm

If the State of Michigan wants to innovate and be a top 10 in education in 10 years they may want to review the way it has defined and used failure.

Do educators have the right answer when they fail children? Is failure a lesson to be learned? Or can failure have an entirely different meaning. The current context of failure is that it is handed out when a child doesn't measure up. Is this the best use of failure. To be used as a tool for those in control to label and define a young person that has barely even begun living life? Or is learning about the meaning of failure in low risk settings and getting comfortable with mistakes, as they are essential to growth, give failure a completely different connotation in life.

For example, the words childish, childlike and youthful have the same denotative but different connotative meanings. Childish and childlike have a negative connotation as they refer to immature behavior of a person. Whereas, youthful implies that a person is lively and energetic.

Let educators be lively and energetic in their teaching of failure in small instances so that resiliency and grit become intrinsic to childrens' well-being. So that failure no longer has a negative meaning. If children were to become comfortable with setbacks and obstacles and not view them as failures, educators would be embracing and promoting growth and not labeling failure.
They would be creatively educating them about life and not giving them a fixed definition of what they are based on a worn out and outdated education system.

Brenda Ammon
brenyammon@gmail.com

Michigan Observer
Fri, 11/10/2017 - 10:05pm

Having resiliency and grit means the ability to deal with negative events. And kids acquire resiliency and grit through experience . It means having learned that you are able to recover from setbacks, that they are not the end of the world, that failing at something does not mean that you are a failure. In "Hillbilly Elegy",J. D. Vance recounts how he and other Marine recruits found they were capable of far more than they ever dreamed. They learned that, growing up, they had acquired "learned dependency". They had never been pushed to their limits, never had to discover what they could do.

In the December 2017 issue of Reason, Lenore Skenazy and social psychologist Jonathan Haidt say, "Parents, teachers, and professors are talking about the growing fragility they see. It's hard to avoid the conclusion that the overprotection of children and the hypersensitivity of college students could be two sides of the same coin. By trying so hard to protect our kids, we're making them too safe to succeed." Exactly.

Michigan Observer
Sat, 11/11/2017 - 9:36pm

Having resiliency and grit means the ability to deal with negative events. And kids acquire resiliency and grit through experience . It means having learned that you are able to recover from setbacks, that they are not the end of the world. In "Hillbilly Elegy",J. D. Vance recounts how he and other Marine recruits found they were capable of far more than they ever dreamed. They learned that, growing up, they had acquired "learned dependency". They had never been pushed to their limits, never had to discover what they could do.
In the December 2017 issue of Reason, Lenore Skenazy and social psychologist Jonathan Haidt say, "Parents, teachers, and professors are talking about the growing fragility they see. It's hard to avoid the conclusion that the overprotection of children and the hypersensitivity of college students could be two sides of the same coin. By trying so hard to protect our kids, we're making them too safe to succeed." Exactly.

By the way, Ms. Ammon never responded to my request for an explanation of the meaning of the following gobbledegook: "The world lacks love. This stems from many causes. However, a radical mutation in brains cells and insecurities that develop in life from being indoctrinated into the current education system can profoundly impact society."

Rich
Tue, 11/07/2017 - 12:03pm

Best scene in a movie was in "Platoon" when a kid got shot and was screaming his head off in enemy territory. The Sergeant grabbed him by the neck and told him to shut up and suck it up. Of course, that was just a movie and not reality, but the fact is that way too many opioids are prescribed. The maximum prescription size should be 10 pills, with a visit to the doc to get any refill. Perhaps then, people will be more cognizant as to how bad the pain really is. No need to take any pills unless the pain level is an 8 or higher (the med profession pain level scale). It is amazing how much pain the human body can tolerate when no quick easy fix is available.

Laurel Raisanen
Tue, 11/07/2017 - 2:28pm

While in the hospital (Gerber- in Fremont) after hip replacement, everyone...and I mean everyone...kept inquiring about what number would I rate the pain I was in, even to the point of chastising me when I refused drugs for pain. I think pill pushing in hospitals are a leading cause of opioid addiction and I congratulate U-M for leading the battle.

Matt
Tue, 11/07/2017 - 5:43pm

Your story brings up an even more interesting aspect of the Opioid issue. What is the differences in how individuals perceive, tolerate and deal with pain. Why is it that a person such as yourself can deal with pain with very little medication while with many others it is love at first bite leading to a addiction death spiral? Studying this propensity to addiction sounds like a key to finding a solution.

Rick
Sun, 11/12/2017 - 12:17pm

http://www.denverpost.com/2017/11/07/over-the-counter-medicine-as-good-a...

Yup, the over the counter medicines work as well as opioids. But they cost less are often generic so the big Pharma companies won't like this. I hope folks saw the CBS 60 Minutes story on how big Pharma got rid of the people in the DEA who were doing their jobs - too well for 3 big companies who just bought legislators to tell DEA to fire them.
https://www.cbsnews.com/news/ex-dea-agent-opioid-crisis-fueled-by-drug-i...