Are Surgeons Writing Opioid Prescriptions Too Freely?
Every day, Americans die from opioid overdoses. According to the CDC (United States Centers for Disease Control and Prevention), more than 100 people die every day because of an opioid-related overdose—and the numbers are growing.
What is to blame for the opioid epidemic? Some argue that pharmaceutical companies provided misleading material to doctors about the addictive nature of opioids and that they provided incentives to physicians who prescribed them. However, others state that physicians are simply too quick to provide strong opioids in excessive amounts to patients after surgeries and other procedures.
According to MedPage Today, Johns Hopkins University conducted an internal study that examined the use of opioid pills in orthopedic surgery patients. The researchers discovered that most patients did not use all of the pills they were prescribed and were not advised as to how they should dispose of the extra medication.
Dr. Mark Bicket led the study and published a meta-analysis in August of 2017. The data revealed that between 42 percent and 71 percent of opioid pills were unused after surgery.
A reporter from Kaiser Health News, Michelle Andrews, recalled the events following a minor laparoscopic knee surgery. Her surgeon prescribed 90 Percocet pills. Surprised, Andrews asked her surgeon why she had been given such a large prescription. He responded that 90 Percocets was the standard in the hospital’s system for knee procedures. Andrews said that her doctor commented, “If you had real surgery, like a knee replacement, you wouldn’t think  is so many.”
Andrews did not comment on what she did with her leftover medication. However, in Dr. Bicket’s study, the researchers found that safely disposing of leftover medication was not a common practice among surgery patients. Patients in the research group often tossed their leftover pills in the garbage or flushed them. Others held on to them in case they had subsequent pain. Some even passed them on to family and friends who suffered from pain. Of course, this is likely illegal.
A different study from JAMA Surgery followed a group of patients in Boston. The study uncovered an alarming amount of “potential over prescription.” Many of the patients were released with opioid prescriptions—even if they had not received any during their final 24 hours in the hospital. Nearly half—more than 40 percent—of the patients who had not received opioids during the last 24 hours of their stays were given prescriptions for opioid painkillers.
But how often do surgery patients actually get hooked on opioid painkillers? According to a study from JAMA Surgery, roughly 1 in 16 patients will develop an opioid addiction after undergoing surgery.
In that study, the data of approximately 36,000 surgical patients were analyzed. Interestingly, how serious the surgical procedure did not seem to affect whether the patient would continue using opioids for more than 90 days. The risk factors that did affect how long patients continued to us opioid painkillers were the presence of mood disorders, substance abuse (including tobacco, alcohol, and other substances), and whether there were any pre-surgical pain diagnoses.
Dr. Chad Brummett, who led the study, explained, “This suggests [persistent opioid] use is not due to surgical pain but addressable patient-level predictors.”
Previous studies seemed to have parallel findings. For example, a 2016 submission to JAMA Internal Medicine concluded that patients who had no experience taking opioid medications were at a higher risk of long-term opioid use (more than 120 days or at least ten consecutive prescriptions) when compared with patients who had not undergone surgery and had no history of opioid use.
During a 2013 presentation at the North American Spine Society, researchers commented that around one-third of back surgery patients were still taking opioids a year out from their surgeries. Around half of the patients who had been prescribed opioids before their surgeries were still taking them. Roughly 18 percent of those who had not been prescribed opioids were still taking them a year after surgery.
However, what can be done to curb this problem? Some suggest using non-opioid painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs). However, some physicians feel that NSAIDs are inadequate for certain types of surgical procedures.
Recently, a clinical trial focused on a substance called gabapentin. Patients in the trial were undergoing different types of orthopedic surgeries, both laparoscopic and open. Others were receiving mastectomies. The patients either received gabapentin or placebo. All of the patients were prescribed a post-op opioid. The patients who took gabapentin stopped taking opioids after an average of 25 days. In the placebo group, the average was 32 days. In the study, the authors noted that gabapentin had “a modest effect on promoting opioid cessation after surgery.”
Dr. Suneel Kamath has another theory on why doctors may prescribe so many opioids—they want to be liked by their patients. Dr. Kamath noted, “To some extent, human nature drives physicians to prescribe more opioids to make patients happy.” Dr. Kamath added that refusing to prescribe opioids when asked to do so by patients could trigger an unpleasant conversation at times. Dr. Kamath explained, “I have to believe that at some point in residency, I gave a patient opioids to avoid the emotional toll of the conflict and to move on more quickly to my other patients. I suspect I am not alone.”
Can pharmaceutical companies be held liable for injuries and deaths caused by opioids?
All manufacturers, whether they make medications or toys or pet food, have a duty to produce items that are safe for consumption. If a company produces an item that is harmful—even if that company had no intention of doing so—the company may be held liable for injuries that result.
In general, there are three types of product defects that may be actionable in a products liability lawsuit:
- Manufacturing defects
- Design defects
- Marketing defects
A product may have a single defect, or it may possess all three types of defects.
Manufacturing defects happen when there is an error in the production or distribution of the product. Using the wrong type of ingredient in a product would be an example of a manufacturing defect if the use of that ingredient caused injuries to consumers.
Design defects occur when there is an issue with the design of the product itself. For example, if a medication was designed in such a way that caused negative side effects, a design defect lawsuit may be appropriate.
With a marketing defect, the company has failed to provide proper warnings or instructions with a product. For example, if a medication is known to interact with certain drugs, but no such warning has been provided, those who take the medication and are injured because of the dangerous interaction may be able to file a lawsuit.
If a claimant prevails in a lawsuit, the claimant may be entitled to damages, such as lost wages, medical expenses, and other costs.
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