Prescribed a Painkiller? If It’s an Opioid, Read This First

Prescribed a Painkiller? If It’s an Opioid, Read This First

Prescribed a Painkiller? If It’s an Opioid, Read This First | Johns Hopkins Medicine

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Maybe you’ve been dealing with chronic pain for a long time. Maybe you’re recovering from surgery and you need short-term pain relief. Whatever the case, you may find yourself with a modern dilemma: whether or not to take prescription pain medication.

Most of the commonly prescribed drugs in this category contain opioids, a class of highly effective but highly addictive pain relievers — which includes oxycodone, codeine and morphine. Although opioids have their place in pain control, they can easily be misused, and this misuse is at the heart of the drug epidemic sweeping the nation.

It’s easy to dismiss the problem as something that could never happen to you, but opioid overdose is now the leading cause of accidental death for Americans.

And it’s a problem that’s worse if you’re female: Women are at increased risk of becoming dependent on or addicted to opioids.

Additionally, while the death rate from prescription drug overdoses dramatically increased overall from 1999 to 2010, it rose 400 percent in women compared to 265 percent in men.

Why is this happening? There are multiple reasons why women are quickly becoming the face of the opioid crisis, says Alexis Hammond, M.D., Ph.D., a psychiatrist in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins Medicine.

More Women Are in Pain

“Women are prescribed pain relievers more often than men,” says Hammond, who also sees patients at the Center for Addiction and Pregnancy at Johns Hopkins Bayview Medical Center. “Part of that has to do with women tending to have lower pain tolerance in general and being more ly to experience chronic pain conditions.”

Women suffer from migraine headaches and neck, facial and lower back pain at up to twice the rate men do. In addition, women are more ly to develop conditions that cause chronic pain. For example, women are three times more ly to develop rheumatoid arthritis and four to seven times more ly to develop fibromyalgia than men are.

“Another component of women being on higher doses of painkillers and using them for a longer period of time has to do with our culture,” explains Hammond. “Unfortunately, it has historically been more socially acceptable for women to ask for help, while men may feel they have to just grin and bear it.”

Once women start taking prescription opioids, they may become dependent on them more quickly than men. Additionally, women are more ly to have depression and anxiety than men and may use opioids as a way to self-medicate a mood disorder.

Some studies, says Hammond, are raising concerns about one more way opioids may be hooking people: The research indicates that long-term opioid use may produce changes in the brain that can make you more susceptible to experiencing pain. That, in turn, makes you want more painkillers.

Even worse? Many people with an opioid addiction eventually turn to heroin, an opioid that’s cheaper to buy on the street than illegal prescription drugs. Although you might think of heroin as a street drug and not related to prescription medications, four five new heroin users first became addicted to prescription painkillers.

Heroin is not dangerous simply because it’s a street drug. “Often, heroin is mixed with fentanyl, which is a very strong opioid and has led to a lot of overdose deaths,” says Hammond. “Using street drugs is so dangerous because you don’t know what’s in them.”

But you don’t have to be on heroin to overdose. You can accidentally overdose if you’re taking a mix of prescriptions or if you drink alcohol while taking opioids, explains Hammond. If you’re taking more than one prescription medication, check with your doctor to see if the drugs have any dangerous interactions.

Signs of Opioid Dependence and Misuse

Opioid dependence is a term used to describe the way your body adapts and begins needing opioids to avoid negative effects.

“If you find that you’re taking medication more frequently than prescribed — say every four hours instead of six — or need frequent refills or your pain is not well-managed, you should talk to your doctor,” says Hammond.

Your body could be developing a tolerance to the drug, which makes you need more medication to achieve the same pain relief.

Another sign of opioid dependence is experiencing withdrawal symptoms in the absence of medication, such as:

  • Agitation and anxiety
  • Sweating
  • Insomnia
  • Muscle aches
  • Abdominal cramping and diarrhea
  • Nausea and vomiting

Misuse typically refers to behavior associated with drug use. If you find you’re using prescription opioids for the feeling it gives you (the “high”) instead of pain control, that’s a sign of an opioid use disorder, or addiction. If you can’t stop using the drugs despite negative consequences at work, school and home, that’s also a clear sign of a problem. 

Opioid Alternatives

Taking an opioid to relieve pain isn’t your only option. Ask your doctor about other types of medications that can ease pain such as non-steroidal anti-inflammatory drugs (NSAIDs) naproxen.

Even some antidepressants, such as duloxetine, may work well to control chronic pain, Hammond says.

Besides medications, you can also try physical therapy, massage therapy, heating pads, acupuncture and lifestyle changes such as increasing exercise and losing weight. 

“As doctors, we want your pain to be well-controlled, but we also want to make sure we’re not getting to the point of misusing opioids,” says Hammond. “Some people may do well on long-term opioids. But for most people, there are other medications that are better for chronic pain.”

If you think you are misusing opioids or have become dependent on them, talk to your doctor about appropriate next steps. You can also learn more about our addiction treatment services or explore our opioid resources site for further information on opioids, the science of addiction, and how to prevent and treat opioid dependence.


Six in ten adults prescribed opioid painkillers have leftover pills

Prescribed a Painkiller? If It’s an Opioid, Read This First | Johns Hopkins Medicine

In the midst of an epidemic of prescription painkiller addiction and overdose deaths, a new Johns Hopkins Bloomberg School of Public Health survey suggests that more than half of patients prescribed opioids have leftover pills — and many save them to use later.

The researchers, reporting June 13, 2016 in JAMA Internal Medicine, also found that nearly half of those surveyed reported receiving no information on how to safely store their medications, either to keep them from young children who could accidentally ingest them or from adolescents or other adults looking to get high.

Nor were they given information on how to safely dispose of their medications.

Fewer than seven percent of people with extra pills reported taking advantage of “take back” programs that enable patients to turn in unused pain medication either to pharmacies, police departments or the Drug Enforcement Administration for disposal.

“These painkillers are much riskier than has been understood and the volume of prescribing and use has contributed to an opioid epidemic in this country,” says study leader Alene Kennedy-Hendricks, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School. “It's not clear why so many of our survey respondents reported having leftover medication, but it could be that they were prescribed more medication than they needed.”

Says the study's senior author Colleen L.

Barry, PhD, MPP, a professor who directs Bloomberg's Center for Mental Health and Addiction Policy Research: “The fact that people are sharing their leftover prescription painkillers at such high rates is a big concern. It's fine to give a friend a Tylenol if they're having pain but it's not fine to give your OxyContin to someone without a prescription.”

Over the past decade, there has been a sharp increase in the rates of prescription painkiller addiction and overdose deaths. Drug overdose — the majority of which involve opioid pain relievers — was the leading cause of injury death in 2014 among people between the ages of 25 and 64, and drug overdose has surpassed car crashes as the leading cause of injury death among this group.

In March, the U.S.

Centers for Disease Control and Prevention urged doctors to avoid prescribing powerful opioid painkillers for patients with chronic pain, saying the risks from such drugs outweigh the benefits for most people.

Prolonged use of these medications can lead to addiction, putting people at much higher risk for overdose and raising the risk of heroin use since it is cheaper, worsening the heroin epidemic.

For the study, a collaboration between the Johns Hopkins Center for Mental Health and Addiction Policy Research and the Johns Hopkins Center for Injury Research and Policy, the researchers used GfK's KnowledgePanel to construct a national sample of 1,032 U.S.

adults who had used prescription painkillers in the previous year. The survey was fielded in February and March 2015. Among those who were no longer using prescription pain relievers at the time of survey (592 respondents), 60.6 percent reported having leftover pills and 61.

3 percent of those with leftover pills said they had kept them for future use rather than disposing of them.

Among all respondents, one in five reported they'd shared their medication with another person, with a large number saying they gave them to someone who needed them for pain. Nearly 14 percent said they were ly to share their prescription painkillers with a family member in the future and nearly eight percent said they would share with a close friend.

Fewer than 10 percent said they kept their opioid pain medication in a locked location. Nearly half said they weren't given information on safe storage or proper disposal of leftover medication.

More than 69 percent of those who got instructions said they had received information about turning over the remaining medication to a pharmacist or a “take back” program, but few actually did.

Fewer than 10 percent reported throwing leftover medication out in the trash after mixing it with something inedible used coffee grounds, a safe method for disposing of medication.

Kennedy-Hendricks says that physicians should, when prescribing these medications, discuss the inappropriateness of sharing and how to safely store and dispose of them.

“We don't make it easy for people to get rid of these medications,” she says. “We need to do a better job so that we can reduce the risks not only to patients but to their family members.”

Says Barry: “We're at a watershed moment. Until recently, we have treated these medications they're not dangerous. But the public, the medical community and policymakers are now beginning to understand that these are dangerous medications and need to be treated as such. If we don't change our approach, we are going to continue to see the epidemic grow.”

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Materials provided by Johns Hopkins University Bloomberg School of Public Health. Note: Content may be edited for style and length.


Johns Hopkins Releases Opioid Prescribing Recommendations for Surgeries

Prescribed a Painkiller? If It’s an Opioid, Read This First | Johns Hopkins Medicine

AUGUST 14, 2018

Kevin Kunzmann

What is ly the first national guidelines for operation-specific opioid prescription has been released by a panel of health care providers and patients at Johns Hopkins University. The guideline recommendations—which were the premise of limiting opioid prescribing by operation rather than a blanket approach—generally call for the reduction of prescribing for different 20 common operations. The expert panel of 30 members from 6 relevant groups (including surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients, and pharmacists) developed consensus ranges for outpatient opioid prescribing for opioid-naïve adult patients following discharge for 20 common procedures across 8 surgical specialties. The guidelines are intended for patients without chronic pain undergoing uncomplicated procedures. The panel concluded that the recommended maximum number of 5mg opioid tablets prescribed per patient should vary among the procedures. They recommended zero opioid tablets for 3 (15%) procedures, 1-15 tablets for 11 (55%) of the procedures, and 16-20 tablets for 6 (30%) of the procedures (median= 12.5 tablets). Overall, patients to have undergone the listed procedures voted for lower prescription rates than the surgeons who perform the procedures. Orthopaedic surgery procedures drew the highest range of opioids, with the panel voting for a range 0-20 opioid tablets for 3 of the 4 listed orthopedic procedures. Meanwhile, otolaryngology procedures warranted the lowest range of opioids, with the panel recommending 0 pills for cochlear implants and 0-15 pills for thyroidectomies. Ibuprofen was recommended for all patients by the panel, unless it was deemed medically contraindicated. The recommended minimum number of prescribed opioid tablets for each procedure was, of course, zero.

Martin Makary, MD, MPH, study senior author and a professor of surgery and health policy expert at the Johns Hopkins University School of Medicine, said the guidelines should “reset defaults that have been dangerously high for too long.”

“It’s unfortunate guidelines haven’t already existed,” Makary said in a statement. “Giving patients dangerous opioid pills they don’t need is part of how we got into this opioid crisis in the first place.” Though the guidelines are not held as enforced practice and tackle a health condition (pain management) which requires patient-tailored flexibility, Makary expressed hope they will serve as a foundation by which doctors can collectively limit the spread of opioid addiction. “Anywhere in range agreed upon by the panel represents a major improvement from current practice,” Makary said.

The guidelines, “Opioid-Prescribing Guidelines for Common Surgical Procedures: An Expert Panel Consensus,” were published online in the Journal of the American College of Surgeons.


Opioids After Surgery: What Is the Right Number of Pills?

Prescribed a Painkiller? If It’s an Opioid, Read This First | Johns Hopkins Medicine

What’s the right painkiller prescription to send home with a patient after gallbladder surgery or a cesarean section?

That question is front and center as conventional approaches to pain control in the United States have led to what some see as a culture of overprescribing, helping spur the nation’s epidemic of opioid overuse and abuse.

The answer isn’t clear-cut.

Surgeon Marty Makary wondered why and what could be done.

So, Makary, a researcher and a professor of surgery and health policy at Johns Hopkins School of Medicine in Baltimore, took an innovative approach toward developing guidelines: matching the right number of opioid painkillers to specific procedures.

Dr Marty Makary, who is leading an effort to curb overprescribing by offering procedure-specific guidelines for opioid painkillers. (Courtesy of Johns Hopkins Medicine)

After all, most doctors usually make this decision one-size-fits-all recommendations, or what they learned long ago in med school.

Even Makary admitted that for most of his career he “gave [painkillers] out candy.”

In December, he gathered a group of surgeons, nurses, patients and other leaders, asking them: What should we be prescribing for operation X?”

The answer was illuminating.

“The head of the hospital’s pain services said, ‘You’re the surgeon, what do you think?’” recalled Makary.

Makary didn’t know. Nor did the resident. And the nurse practitioner, who often is the one who most closely follows up with patients, said it varies.

“Wow,” recalls Makary of that day when they first considered appropriate limits. “We’re the experts, the heads of this and that, and we don’t know.”

After a quick couple of weeks of intense discussion, Makary’s group reached consensus and gave its blessing to guidelines setting maximum numbers of opioid-containing pills for 20 different common surgical situations, from relatively minor procedures to coronary bypass surgery.

“We’re in a crisis,” said Makary, explaining why the group didn’t go a more traditional route and publish its findings in a medical journal first, which could take months.

Sometimes the right number of opioids is zero, concluded the group.

Indeed, it recommends no opioids for patients heading home after uncomplicated labor and delivery, or after cardiac catheterization, a procedure in which a thin, hollow tube is inserted into the heart through a blood vessel to check for blockages.

For certain types of knee surgery, such as arthroscopic meniscectomy, the guidelines recommend no more than 12 pills upon discharge, while a patient going home after an open hysterectomy could require as many as 20.

Optimally, “no one should be given more than five or 10 opioid tablets after a cesarean section,” Makary said.

Oh, and for cardiac bypass surgery? No more than 30 pills.

But What About The Pain?

Tens of thousands of Americans are dependent upon opioid medications. An increasing number are dying from overdoses, both from prescription medication and street drugs.

Knowing that, Makary, as well as other surgeons, hospitals and organizations, are taking steps to change how they practice medicine.

After all, many experts view the use of opioid prescription painkillers after surgery as a gateway to long-term use or dependence. A study published last year in the journal JAMA Surgery found that persistent use of opioids was “one of the most common complications after elective surgery.”

In that study, University of Michigan researchers found that 6 percent of people who had never taken opioids but received them after surgery were still taking the medications three to six months later.

With about 50 million surgeries that occur in the U.S. each year, “there are millions who may become newly dependent,” said Chad Brummett, the study’s lead author and an associate professor of anesthesiology at the University of Michigan Medical School.

Smokers, and those diagnosed with certain conditions such as depression, anxiety or chronic pain before their operations, were most at risk of long-term use.

Each refill or additional week of use makes for a greater risk of misuse, other studies have shown.

Additional research points to another reason for concern. If patients don’t take all the pills they are prescribed following an operation, those pills can be stolen or diverted to other people, who then run the risk of becoming dependent.

Still, there is debate in medical circles about just how effective recommendations and guidelines will be in stemming the epidemic.

For one thing, some experts worry that if the fight against opioids focuses only on safe prescribing at the expense of seeking alternatives, it may miss the bigger picture.

“Are there better methods than opioids in the first place?” asks Lewis Nelson, chair of emergency medicine at Rutgers New Jersey Medical School. “Could you put a lidocaine patch over the wound or is there a better way to immobilize a joint?”

Studies have shown that sometimes a combination of ibuprofen and acetaminophen can be just as good as or better than opioids.

Alternatives should always be considered first, agreed Makary.

Another concern is that guidelines for prescribing relief — even those aimed at short-duration, acute pain, such as that following surgery — have carryover effects on patients with long-term pain. Advocates say all the attention around prescribing limits have made it difficult for chronic pain patients to get the medications they need.

Some people even apply these concerns to recommendations about the treatment of acute pain.

“It’s important for a physician to have the ability, if they feel there’s a medical necessity, to write a prescription for a longer duration,” said Steven Santos, president of the American Academy of Pain Medicine. “It’s challenging to lump all patients into one basket.”

A Different Focus: Duration

Lawmakers — desperate to address overdose problems that are destroying families and communities — have gone where they usually don’t: setting specific rules for doctors.

Legislatures in more than a dozen states, including New Jersey, Massachusetts and New York, have set restrictions, often on the number of days’ worth of pills prescribed for acute pain.

“States said that since physicians haven’t self-regulated, we’re going to do it for them,” said Nelson at Rutgers.

Congress, too, is getting involved, holding a flurry of hearings this spring, and considering legislation that would, among other things, set limits on prescribing opioids for acute pain. The recently passed federal spending bill includes $3 billion in new funding to help states and local governments with opioid prevention, treatment and law enforcement efforts.

To be sure, the medical profession has also responded to the crisis — with medical societies and other expert groups offering a growing number of standards for prescribing opioids.

Some are fairly generic, recommending the lowest dose for the shortest period of time for acute pain. Some are more prescriptive.

None is meant to address the needs of chronic pain patients or those with cancer.

And state rules vary. New Jersey’s, for example, says patients with acute pain should, initially, get no more than a five-day supply, while Massachusetts sets the cap at seven days for a patient prescribed opiates for the first time.

The Centers for Disease Control and Prevention recommends three days.

Makary and some other experts say that, while well-intentioned, such durational rules are too blunt.

A day’s worth of pills can vary, depending on how often the doctor instructs patients to take them. Under many of the state rules, patients could still head home with more than 50 pills.

“No one should have 50 tabs sitting in their medicine cabinet” for acute pain, said Makary.

Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management, supports guidelines but wants states to take their rules a step further.

“I don’t think the way the states are going at this makes much sense because the issue with overprescribing was quantity, yet they’re passing laws around duration,” he said.

Instead, the laws should require that “if physicians are going to prescribe more than three days, they have to warn the patients that this is an addictive drug and that taking it every day for as little as five days may cause them to become physiologically dependent,” Kolodny said.

That would create a disincentive to prescribing more than three days’ worth of opioid painkillers, he added, and lead to more informed patients among those who need a longer supply.

Rutgers’ Nelson, who sat on the CDC panel that developed recommendations, said durational rules — those adopted by the states — can be effective.

“I personally think three days is enough,” said Nelson. “That doesn’t mean pain goes away in three days, but most people get better within three to five days.”

That said, Nelson called the Hopkins’ approach an “excellent idea” and one he has tried to do. “It’s a lot harder than it sounds because of the large number of procedures and the diversity of patient needs,” he said.

To get around overprescribing — or setting one-size-fits-all guidelines — physicians at Dartmouth-Hitchcock Medical Center have a developed their own data-based approach.

Dr. Richard Barth, the chief of general surgery at Dartmouth, and colleagues studied 333 patients discharged from the hospital following six common surgeries that included bariatric procedures; operations on the stomach, liver, colon and pancreas; and hernia repair.

Surveying the patients, they asked how many opioid pills they went home with, how many they actually took, how many went unused and how much pain they experienced.

The data helped them land on a way to recommend a specific number of pills. “If they took none the day before discharge, then over 85 percent of patients did not take any when they went home,” said Barth.

Dartmouth-Hitchcock now uses that data as a recommended starting point for physicians.

Under the guidelines, patients taking no opioid pain pills the day before discharge go home with none. Those who take one to three pills get 15, an amount Barth’s study found satisfied 85 percent of patients, and those who took four or more get 30 pills.

“We came out with a very easy to implement and remember guideline,” said Barth. “We actually called patients and asked them how many [pills] they used. That’s what differentiates us from other places.”

Brummett, at Michigan, says the Opioid Prescribing Engagement Network, a collaboration of hospitals, insurers, physicians and others in his state, has used similar data methods to come up with procedure-specific guidelines.

“We’ve taken a data-driven approach,” he said. “We believe patient-reported outcomes are a better way to guide than expert consensus.”

For his part, Makary admitted it is harder to develop guidelines those at Hopkins and Dartmouth, but he said the effort is vital.

“It’s mind-boggling to me” that so many opioid-prescribing guidelines do not specify the procedure, said Makary. “An ingrown toenail is not the same as cardiac bypass surgery.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


Most prescribed opioid pills go unused, study confirms: Most are improperly stored, as well

Prescribed a Painkiller? If It’s an Opioid, Read This First | Johns Hopkins Medicine

In a review of half a dozen published studies in which patients self-reported use of opioids prescribed to them after surgery, researchers at Johns Hopkins report that a substantial majority of patients used only some or none of the pills, and more than 90 percent failed to dispose of the leftovers in recommended ways.

A summary of the review, published August 2 in JAMA Surgery, highlights the need for more personalized pain management to avoid overprescribing opioids and reduce risks linked to improperly stored opioids in the home.

“Physicians write a lot of prescriptions for patients to fill for home use after they have inpatient or outpatient surgery, but our review suggests that there's a lot we don't know about how much pain medication people really need or use after common operations,” says Mark Bicket, M.D., an assistant professor of anesthesiology and critical care at the Johns Hopkins University School of Medicine and the paper's first author.

The review he and his team published found that 67 to 92 percent of a total of 810 patients in the six studies did not use their entire opioid prescription, yet still held onto them, increasing the risk of misuse, says Bicket. Opioid abuse and misuse rates have been rising in the U.S., adding to what public health officials are calling an epidemic of opioid deaths and overdoses.

Commonly, Bicket notes, prescriptions for opioid pills permit patient discretion for dosing, such as taking one pill every four hours “as needed” for pain. Instead of a one-size-fits-all approach, Bicket says, clinicians need to do a better job of personalizing prescriptions and dosing for each patient.

Some studies suggest that nonopioid drugs such as acetaminophen and naproxen can often suffice for moderate postoperative pain, says Bicket, who also recommends that prescribers spend more time assessing postoperative pain and prescribe smaller amounts of opioids or alternatives as appropriate.

“If we can better tailor the amount of opioids prescribed to the needs of patients, we can ensure patients receive appropriate pain control after surgery yet reduce the number of extra oxycodone and other opioid tablets in many homes that are just waiting to be lost, sold, taken by error, or accidentally discovered by a child.”

To examine the potential prevalence of unused prescription opioids following surgery, the research team searched three published research paper databases from their inception dates through October 18, 2016, collecting data from all studies describing opioid oversupply.

The studies eligible for inclusion in their first round of analysis could be in any language, could involve any type of surgery on adult patients, could include both inpatient and outpatient populations, and had to contain some level of reporting about unused pills.

Of the 2,419 studies screened, the research team identified six that met all eligibility criteria, with a combined total enrollment of 810 patients.

In all, the patients underwent seven types of surgeries, including orthopedic surgery, urologic surgery, dermatologic surgery, thoracic surgery, Cesarean section, dental surgery and general surgery.

Among these procedures, thirty patients were women who had had Cesarean section, and some 65 percent (523/810) of the patients had outpatient surgery.

To calculate the average number of patients who had an oversupply of a prescription opioid, the research team added the number of patients who didn't fill their opioid prescription to those who filled their prescription but reported unused opioids. This sum was then divided by the total number of patients who received an opioid prescription.

The researchers found that between 67 and 92 percent of patients reported unused opioids. A small number of patients either did not fill their opioid prescription (range of 0 to 21 percent) or filled the prescription but did not take any opioids (range of 7 to 14 percent).

Overall, Bicket reports, anywhere from 42 to 71 percent of prescribed pills dispensed went unused among the 810 patients. A majority of patients reported they stopped or used no opioids due to adequate pain control, while 16 to 29 percent of patients reported they stopped because of opioid-induced side effects, such as nausea, vomiting or constipation.

In two of the studies that looked at storage safety, the Johns Hopkins analysis showed that 73 to 77 percent of patients reported that their prescription opioids were not stored in locked containers. Five studies that examined patients' opioid disposal practices showed that only 4 to 30 percent of patients reported that they disposed of their unused opioids or said they planned to.

A smaller proportion of patients (4 to 9 percent) said they considered using or had used a disposal method recommended by the Food and Drug Administration, such as returning unused medications to a pharmacy or flushing them down a toilet.

Bicket notes the study's limitations included variability in the quality of the studies reviewed and differences in the questionnaires used to ask patients about how much opioid medication they used. Data on usage and disposal were also the self-report of patients, and the studies did not use pill counts to independently verify unused tablets.

“We need to do more research into why some people need more medication than others.

Perhaps there are some characteristics in a patient, such as whether he/she is on opioids before the surgery or has certain genetic markers, that can let me determine that one needs more pain medication than another,” says Bicket.

For now, he says, there are no proven ways to absolutely verify pain levels or predict them, but the high rate of unused opioids found in their review suggests that doctors can often prescribe less, because patients often need less.

Bicket cautions that his research is not intended to encourage withholding opioids from people in pain, and says he and his team are conducting research to better understand patients' pain experiences in a bid to someday identify better ways to optimize the way in which opioid are prescribed after surgery.

At the end of the day, though, Bicket says that “we need better data and tools to ensure patients have access to adequate pain relief after surgery while reducing the risks of opioid overprescribing.”

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Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.


Opioid-Prescribing Guidelines for Common Surgical Procedures: An Expert Panel Consensus

Prescribed a Painkiller? If It’s an Opioid, Read This First | Johns Hopkins Medicine

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