Hospital to introduce opioid plan to tackle risk of post-surgery dependence

The move comes after the peak body for hospital pharmacists last year raised the alarm over the fact that more than 70% of hospitals send post-surgical patients home with strong opioids ‘just in case’.
 
Perth’s Sir Charles Gairdner Hospital will move to introduce weaning plans in coming months, starting with general medicine before rolling out hospital-wide, according to a WA Health spokesperson. 

The move comes after hospital intensivist and co-director of research, Adjunct Associate Professor Matthew Anstey, found only 24% of patients had a weaning plan after being prescribed opioids in a survey of almost 100 patients from the general surgery, medical and orthopaedics wards.
 
In a presentation at the recent Choosing Wisely Australia meeting in Melbourne, Associate Professor Anstey said up to 45% of patients who do not take any opioids on their last day of hospital are prescribed them on discharge.
 
And only 16% are given a quantity of opioids matched to their specific needs, with the majority of patients receiving a standard full box of oxycodone or pregabalin.
 
Associate Professor Anstey said the results are a concern, particularly given the fact opioid-related deaths now far outweigh deaths linked to heroin. He cited US data that one in 16 patients who were opioid-naïve before being prescribed opioids become long-term users.
 
Sir Charles Gairdner will soon require its doctors to develop a plan to wean patients off post-surgical opioids and to give a recovery timeline.
 
Associate Professor Anstey told the meeting a key part of the problem was the fact there were minimal guidelines available regarding the correct quantity of opioids to prescribe.
 
He said the pendulum had swung too far from under-treatment of pain to over-treatment.
 
‘People come in with pain and we want to help them, but there’s not much evidence to show doctors how much to give them,’ he said. ‘Some opioid naïve end up with opioid dependence.
 
‘Obviously we’ve seen the stats in the US, but the statistics in Australia aren’t that great, either.’
 
Associate Professor Anstey told a story that had stuck with him about treating an 18-year-old who had been prescribed oxycodone after having surgery to have a screw put in his fractured ankle. The young patient then went to a party and drank alcohol.
 
The combination of oxycodone and alcohol sent him into respiratory arrest.
 
‘He basically left the ICU a month later in a persistent coma, which is probably the worst outcome,’ Associate Professor Anstey said.
 
‘When I give talks on this in the hospital, I say that every doctor prescribes opioids, and what you do every day matters more than what you do once in a while.’
 
‘We’re not good at providing guidelines [on this]. What people do in prescribing tends to be what they think is the right practice. What we’re trying to move towards is what would be expected for similar practitioners – “You’re having your hip done, this is what we’d expect”.
 
‘We’ve got antimicrobial stewardship, but we don’t have pain medicine stewardship and that’s what we’re trying to work towards.’

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