Orthopaedic Department-Service Strategies

Orthopedic Department Opioid Safety Strategy

The following are part of a strategy to keep you as safe and as comfortable as possible:

  1. Only one doctor can give you opioids.
  2. Patients on suboxone, methadone, or daily opioids get opioids from their PCP.
  3. New office patients with long-standing conditions will not be prescribed opioids.
  4. Orthopedic surgeons do not use long-acting opioids.
  5. Orthopedic surgeons do not treat persistent pain with opioids.
  6. We will check statewide databases prior to prescribing opioids.
  7. After small procedures (e.g. trigger finger, carpal tunnel release, simple laceration, etc.) patients will receive:
    1. No more than 10 pills of 5mg hydrocodone/325 mg acetaminophen pills
    2. No refills
  8. After fracture, laceration, other injuries
    1. Most injuries are treated with non-opioid pain medication (e.g. ibuprofen, acetaminophen), splint, ice, elevation, and reassurance. 
    2. Some very unstable or complex fractures may, on occasion be treated with codeine or hydrocodone prior to surgery.
  9. Moderate procedures (e.g. open reduction internal fixation of a distal radius or humerus fracture; shoulder arthroscopy; etc.)
    1. A single prescription for no more than 20 pills of 5mg oxycodone/325 mg acetaminophen.
    2. The second and final prescription will be for hydrocodone.
  10. Large procedures (e.g. spinal fusion; ORIF acetabular fracture; etc.)
    1. A single prescription for no more than 40 pills of 5mg oxycodone/325 mg acetaminophen.
    2. The second and final prescription will be for hydrocodone.
  11. Consider using Tylenol or ibuprofen or both instead of opioids
  12. Use as little opioid medication as possible.
  13. Patients with more pain than expected will be evaluated in the office. 

Orthopaedic Service Opioid Safety Strategy

  • Codeine, hydrocodone (Vicodin, Norco), oxycodone (Percocet, Oxycontin), and hydromorphone (Dilaudid) are opioids.
  • Opioid can relieve pain.
  • Opioids are also addictive and deadly.
  • Opioids are tightly controlled and monitored by the federal government through the Drug Enforcement Agency (DEA). 

The United States accounts for 80% of the opioid consumption in the world.  Research consistently shows that Americans take more opioid medications and are less satisfied with pain relief after injury or surgery than patients with similar problems in other parts of the world.  The leading cause of death among young adults in the United States is accidental poisoning.  Overdose of prescription opioid pain medication and heroin accounts for 90% of these deaths. The prescription opioids that are causing these deaths have been traced to physician over-prescribing.  

Research has shown:

    1. There is wide variation in the amount of opioids prescribed by various providers. 
    2. Most patients take little or no opioids after minor procedures and wean off as quickly as possible after more substantial injuries and surgeries. 
    3. Continued opioid use is indicative of stress, distress, or less effective coping strategies.
    4. Opioid strategies such as this one limit over-prescription and misuse of opioid pain medications and get patients the care they need and deserve.

For our patients' wellbeing and because of ever tightening regulations and oversight, we have adopted the following strategy for the use of opioids to treat pain after surgery and injury.  This strategy does not apply to patients that are dying from cancer.

    1. Each patient receives opioid pain medications from a single provider.
    2. For patients on suboxone or long-term opioids, their primary care doctors should be that single provider. 
    3. New patients with non-acute problems are not prescribed opioids.  
    4. Check statewide databases before prescribing opioids.
    5. We provide a set amount of opioids for pain after injury or surgery.
    6. Orthopaedic surgeons do not give opioids for chronic pain.
    7. Use of extended-release opioids for post-operative pain is generally "off-label" (unapproved) and discouraged except in approved research protocols.
    8. Goals for type and amount of opioid medication
      1. After small procedures (e.g. trigger finger, carpal tunnel release, excision of a small benign tumor, etc.)
      2. After fracture, laceration, other injuries
      3. Moderate procedures (e.g. open reduction internal fixation of a distal radius or humerus fracture; shoulder arthroscopy; etc.)
      4. Large procedures (e.g. spinal fusion; ORIF acetabular fracture; etc.)

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