Opioids are powerful drugs that decrease pain, but they can also lead to addiction and deadly overdose if not taken with care. This class of narcotic pain medications are commonly prescribed after both minor and major surgeries.

The World Health Organization says about 34 million people worldwide used opioids at least once in 2016. Since prescribers have little guidance available on opioids, overprescribing is a major contributor to the opioid epidemic currently claiming 130 American lives every day*. In addition, with up to 92% of patients having leftover opioids after common operations, these pills often end up in the wrong hands**.

“The misuse of and addiction to opioids is a serious national crisis right now that is affecting public health as well as social and economic welfare,” said George Burnett, M.D., Medical Director of Behavioral Health for Independent Health. “The Centers for Disease Control and Prevention (CDC) estimates that 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers in 2017, with more than 47,000 Americans dying as a result of an opioid overdose. For many of these people, their first exposure to opioids came after undergoing surgery.”

In his role at Independent Health, Dr. Burnett is responsible for assisting in the development and implementation of health care strategy and policies related to behavioral health, including substance abuse and chemical dependencies. He says it’s very important that, prior to having any type of surgery patients talk with their doctor about how they will feel after surgery and whether they will need opioid pain medicine.

If your doctor says opioids aren’t necessary

If your doctor thinks you won’t be in a lot of pain after surgery, other types of pain medicine may be needed. He or she may recommend over-the-counter pain relievers like acetaminophen (Tylenol and generic), ibuprofen (Advil, Motrin IB, and generic), and naproxen (Aleve and generic). In addition, depending on the type of surgery you had, your doctor may also suggest safe, non-drug alternatives, such as physical therapy.

If your doctor says opioids are necessary

If your doctor thinks you will be in a lot of pain after surgery, opioids might be the right choice. Opioids include hydrocodone (Vicodin and generic) and oxycodone (OxyContin, Percocet, and generic). These medicines should only be used to treat extreme short-term pain, like the kind you may feel after surgery. They are not intended to treat conditions that involve long-term pain.

“If it’s determined that you need an opioid, you and your doctor should talk about all the medicines and supplements you already take and how much alcohol you drink,” said Dr. Burnett. “This will help make sure that you are taking any pain medicine safely.”

Stick to the lowest dose

If you need to use opioids, Dr. Burnett says your doctor should prescribe the lowest possible dose. Three days or fewer will often be enough, and more than seven days are only rarely needed for urology procedures.

According to the CDC, taking opioids for more than three days will increase your risk of addiction. If you’re still in pain after three days, use over-the-counter medicines as recommended by your doctor.

“Your doctor or pharmacist can help you take those medicines safely. They may also suggest non-drug ways to ease your pain, such as heat or cold therapy,” said Dr. Burnett.

In addition, Dr. Burnett says patients need to know the side effects and risks of pain medications before taking them. The possible side effects of opioids include abdominal cramps, constipation, headaches, nausea, sleepiness, vomiting and a fuzzyheaded feeling.

As for potential risks, research has found that between 8 and 12 percent of patients prescribed opioids develop an opioid use disorder. Also, the risk of overdose from opioids is high because the amount that can cause an overdose is not much higher than the amount used to treat pain.

“Addiction to opioids does not discriminate. It can happen to anyone, regardless of race, gender, income level or social class,” said Dr. Burnett. “Make sure you discuss the risks with your doctor and what can be done to prevent addiction problems should you be prescribed an opioid following surgery.”

Reference: choosingwisely.org

*Opioid Overdose: Drug Overdose Deaths. Centers for Disease Control and Prevention. Updated 2018 Dec 19; cited 2019 Feb. 13.

**Prescription opioid analgesics commonly unused after surgery: a systematic review. Bicket, M.C., Long, J.J., Pronovost, P.J., Alexander, G.C., Wu, C.L. (2017). JAMA Surgery, 152(11), 1066-1071. PMID: 28768328 doi:10.1001/jamasurg.2017.