Dartmouth-Hitchcock achieves 53% reduction in opioid prescriptions for outpatient procedures

A team of surgeons at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., conducted an initiative that reduced opioid prescriptions for a number of minor procedures by 53 percent. Despite the reduction in prescriptions, patients still didn't use all the pills they were prescribed, according to a new study published in the journal Annals of Surgery.

With the nation currently embroiled in what some experts have called the worst drug epidemic in modern American history, both the healthcare industry and the government have been working to develop strategies to curb rates of abuse.

To limit overprescribing at Dartmouth-Hitchcock, the team assessed opioid prescription use among patients who'd undergone one of five outpatient procedures: a partial mastectomy, partial mastectomy with a lymph node biopsy, gallbladder removal, laparoscopic inguinal hernia repair and open inguinal hernia repair. Researchers surveyed these patients and found they only used 28 percent of the opioids prescribed to them.

Subsequently, the team implemented specific guidelines for prescribing opioids and set a maximum number of prescriptions surgeons could give out based on each surgery.
In addition, patients were told to use the opioid medications as a painkilling option second to over-the-counter options like ibuprofen and acetaminophen.

A follow-up survey involving 224 patients found the number of opioid prescriptions dropped from 6,170 to 2,932 — a 53 percent decrease. Patients also used fewer pills after the new processes were implanted. Another follow-up survey involving 148 patients found the group only used 656 of the 1,913 pills physicians prescribed them.

"So you set an expectation in a patient's mind that they are not going to need opioids and that the Tylenol and ibuprofen are going to be good enough to take care of the their pain," said Richard Barth, MD, a surgical oncologist at Dartmouth-Hitchcock and one of the study's authors, according to New Hampshire Public Radio. "And the bottom line is most of the time it did work out just fine."

Among the 148 patients who participated in the follow up survey, only one reported needing an opioid prescription refill. The research team is now compiling data for inpatient surgeries to identify areas where opioid prescriptions may have room for reduction, according to The Washington Post.

"I think [the idea] has potential to have a big impact," Dr. Barth told the Post. "This could easily be done by other general surgeons all across the country."

More articles on opioids: 
West Virginia overdoses overwhelm state burial assistance program 
Healthcare consumers' concerns over narcotic risk is growing, survey finds 
Boston Medical Center receives $25M to launch opioid abuse treatment center

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