BY ALOK SHARAN
The effects of the opioid crisis have been felt across the nation – from small towns to bustling cities. In 2017 there were upwards of 70,000 drug overdose deaths, the highest number for any single year in U.S. history. The state of New York is no exception. Between 2015 and 2016 New York saw the single greatest annual increase in drug-related deaths in six years. When we examine data on the opioid epidemic closer to home, research shows that overdoses and fatalities have also plagued Westchester County.
New York has implemented several initiatives to help turn the tide of this crisis. Gov. Andrew Cuomo launched a statewide Heroin Task Force comprised of health care providers, policy advocates, educators, parents and those in recovery to leverage their experiences and expertise to develop a comprehensive plan to tackle the opioid crisis.
To effect meaningful change when it comes to this epidemic, we must first understand one of its root causes – opioid overprescribing following surgery. We need to develop a comprehensive and unobstructed review of the situation and, in short, stop shying away from the glaring reality of the potential dangers of prescription opioids. Opioids are the most widely prescribed class of drugs in the U.S. and are considered the mainstay of postsurgical pain management, with nine in 10 patients receiving opioids after surgery. Consequently, surgery has become an unintentional gateway to persistent opioid use, meaning patients are still taking these medications three to six months after their surgical procedure. It is imperative that surgeons and health care practitioners be more cognizant of their prescribing habits and, along with patients, become educated on effective non-opioid pain management options for use before, during and after surgery.
As a spine surgeon in Westchester County, I am conscious of my opioid prescribing habits and how I manage my patients’ postsurgical pain. Patients often assume spine surgery is an extremely painful procedure. However, with the use of new technologies and non-opioid options, this has changed. It is especially important to me that I have conversations with patients about effective pain management options. To manage postsurgical pain and simultaneously limit opioid prescribing, I use a non-opioid option called Exparel. It is a long-acting numbing medication injected during spine surgery that can provide patients with pain control during the first few days following surgery, when pain is often at its worst. In my experience, patients have reported a 75 percent reduction in postsurgical pain and – of the few patients who do require opioids – 70 percent stop use after just one week after surgery. This protocol has yielded a significant and measurable decrease in opioid use among patients while maintaining positive patient outcomes and satisfaction.
We have developed a program called Awake Spinal Fusion whereby we are able to limit the amount of narcotics that are given after surgery while expediting the recovery process. Awake Spinal Fusion involves making a very small incision in the skin which results in faster healing times, reduced postsurgical pain, less muscle injury and better cosmetic outcomes compared to traditional spinal fusion surgeries. In most cases, patients have recovered and are up and moving just a few hours after surgery. At this point 50 percent of our patients are undergoing spinal fusion surgery and going home the same day.
Minimally invasive procedures and non-opioid options are becoming increasingly popular in the midst of the opioid epidemic, as patients and health care practitioners look for new ways to manage pain without exposing patients to opioids after surgery. Ending prescription drug abuse is easier said than done. Patient education is one of the most important and least discussed components of addressing this issue. Prior to performing a surgery, I make sure to discuss my pain management protocol and non-opioid options with each of my patients. Starting these conversations empowers my patients to be active participants in their surgical experience from start to finish. Pain relief is not a one-size-fits-all approach and it should not be treated as such. It’s vital we work together against tired rhetoric that characterizes opioids as the only effective option to treat pain. Non-opioid options are available, effective and offer the additional benefit of eliminating the risks associated with taking prescription opioids without decreasing the quality of patient care.
The opioid epidemic has impacted our entire nation and left destruction in its path. While it will take time to rebuild and recover from the damage that has been done, we must take steps to create a stronger foundation. I believe that creating open patient-provider conversations on pain management, and the utilization of non-opioid options, are all building blocks for a better future.
Dr. Alok Sharan is an orthopedic spine surgeon at Westmed Medical Group and practices in Yonkers and New Rochelle. He can be reached at 914-831-4160.