Urology practice must-knows for opioid prescribing

November 13, 2018

Patients at greatest risk of complications from opioids are older than 65 years, male, obese, have used opioids prior to surgery, or have elevated comorbidity index scores, according to Francis J. McGovern, MD.

Patients at greatest risk of complications from opioids are older than 65 years, male, obese, have used opioids prior to surgery, or have elevated comorbidity index scores, according to Francis J. McGovern, MD.

Patients with anxiety and depression should be evaluated by a psychiatrist and their anxiety and depression should be optimized prior to major surgery, according to Dr. McGovern.

Patients with previous opioid addiction should be evaluated in collaboration with the anesthesia team, addiction medicine specialist, and urologic surgery team to optimize perioperative pain management, he said.

Also see - Opioids crisis: Urologists are part of the problem-and solution

Greg Auffenberg, MD, MS, offered these points from the AUA position statement on opioid use:

Opioid duration, amount. Urologists should be thoughtful about prescribing opioids, providing the lowest possible prescription in the number of pills and strength of medication necessary to meet patients’ pain needs while encouraging multimodal pain management with agents such as Tylenol, Motrin, and others.

Make use of prescription drug monitoring programs. Many states offer online state-based tracking programs where providers can determine whether a patient has filled prescriptions for opioid medications in the recent past. Dr. Auffenberg warned that the quality of these programs varies, so they may not be helpful in all locations, but in states where they are well run they have been shown to reduce rates of inappropriate or over-prescribing.

Opioid use for chronic opioid users or patients with substance abuse disorder. TheAUA endorses and encourages urologists to become familiar with the CDC’s standardized guidelines for prescribing prescription opioids to manage chronic pain. Medically managing chronic pain disorders can be complex and, in some cases, beyond the urologist’s expertise. A team approach can help, as can referring to these guidelines.

Opioid storage, disposal. Urologists should encourage patients to properly dispose of opioid surpluses and explain how this is done. Most communities have options for safe drug disposal through hospitals, pharmacies, or police stations. Urologists should also encourage patients to store their narcotic medications safely at home-in a locked cabinet, for example.

Prescribers are only part of this problem. It’s important for policymakers to focus on the pharmaceutical industry and other stakeholders to take responsibility for the opioid addiction epidemic as well.

 

“Everyone involved in this industry needs to look at their contributions and look for ways to be more responsible and improve the situation,” Dr. Auffenberg said.