WATERTOWN — Prescription opioid pain relievers are among the most commonly misused and abused medicines around the globe, and the north country is no exception.
Since 2010, Jefferson County alone has had 138 confirmed opioid-related overdose deaths. In New York state, enough opioids were prescribed in 2017 for every resident to have 26 pills each.
To combat this, the medical community is under pressure on national, state and local levels to find non-opioid alternatives for their patients.
Dr. Bruce L. Baird, orthopedic surgeon for the North Country Orthopaedic Group, has been addressing the problem head-on with a medication that’s helped cut his opioid prescribing in half.
Dr. Baird said he has worked toward decreasing the amount of opioids used over the past five years, but found his saving grace in 2016 with Exparel, an injectable, long-lasting, non-addictive pain medication.
Exparel requires only one dose, administered by the doctor during surgery, and provides pain control for the first few days after surgery. It’s injected around the surgical site, unlike opioids, which affect the entire body. Often, doctors will choose to combine medications with Exparel to try to limit the amount of medicine needed, therefore limiting the risk of side effects.
Patients to whom Dr. Baird has administered Exparel have, on average, had much faster post-operation recovery.
He also said it leaves patients with less sedation, allowing them to participate in their rehabilitation more aggressively.
Travis A. Taylor, a patient of Dr. Baird’s, said he was discharged from the hospital the day after his spinal fusion surgery last year — a procedure that typically requires a two-day stay.
He said by the night of his surgery, he was sitting up, while most people wouldn’t move at least until the next day. In turn, there is cost savings for both the hospital and the patient.
“Under cost saving practices, we are under a lot of pressure there to get people out of the hospital sooner, so if we can show we can shave one day length of stay off of a knee replacement or back fusion surgery, it makes the hospitals more interested in investing in this kind of medical technology,” Dr. Baird said.
Upon his discharge, Dr. Baird gave Mr. Taylor 24 Oxycodone pills for the week, with no refills. Ten years ago, Dr. Baird said he would be prescribing about 60 pills.
“When I initially looked at the prescription and it was no refills and enough for a week, I was like ‘I don’t know about this.’ I had just been sliced open, my muscles pulled apart and bones scraped. But they were right,” Mr. Taylor said.
Not only does this reduce the risk of addiction for the patient, Dr. Baird said, but it eliminates other potential problems.
“I’d rather have them think I have to use this [prescription] a little bit sparingly, rather than I have them so I should take all 50,” Dr. Baird said. “The other thing with narcotics is if they don’t take them, they end up on the shelf for the kids to grab, or others.”
Mr. Taylor’s surgery was on a Monday and by Thursday, he was off narcotics entirely. His pain was also manageable, Mr. Taylor said, allowing him to return to work part time in just two weeks.
“We use Exparel as part of our standard practice in the appropriate cases now, so all the patient really knows is ‘Well, that wasn’t so bad,’” Dr. Baird said.
With minimal pain, earlier discharge and faster recovery, the downside to the new post-operative treatment is obsolete.
“Patients are bouncing back quicker now than they were 10 years ago, that’s for sure,” Dr. Baird said.
WASHINGTON — U.S. Sens. Kirsten Gillibrand, D-N.Y., and Cory Gardner, R-Colo., announced bipartisan legislation March 15 to combat the opioid crisis.
Modeled after similar state laws, the John S. McCain Opioid Addiction and Prevention Act would limit the supply of initial opioid prescriptions for acute pain to seven days.
The act is hoped to reduce the amount of excess opioids by requiring medical professionals, as part of their Drug Enforcement Agency registration, to certify that they will not prescribe an opioid as an initial treatment for acute pain in an amount that exceeds a seven-day supply. Medical professionals would also not be able to provide a refill.
In regard to chronic pain, the prescription limit wouldn’t apply.
Currently, 15 states, including New York, limit initial opioid prescriptions for acute pain.