Addressing the Opioid Crisis in Canada

The Urgency of the Opioid Epidemic

The opioid crisis has become a pressing issue across North America, with many cities grappling with its effects. Numerous studies have implicated prescription opioids as a significant factor in this crisis, highlighting the irony that medications intended to alleviate pain can lead to harm and, in many cases, fatalities.

Health Canada’s Response

In response to the growing epidemic, Health Canada issued a statement of action in 2017, emphasizing the need to reduce prescription opioids for acute pain management, particularly after surgical procedures. Following these guidelines, surgeons at the London Health Sciences Centre in Ontario sought innovative methods to manage post-operative pain effectively.

The STOP Narcotics Initiative

A team of health professionals developed the STOP Narcotics initiative, which aimed to standardize post-surgery pain management. They identified four key areas for intervention:

1. Patient education
2. Education for healthcare professionals (including surgeons, anesthetists, residents, and nurses)
3. Pain control during surgery
4. Pain management after surgery

Patients received guidance on what to expect post-surgery and were informed about available pain management options. Prior to the procedure, surgeons and anesthetists collaborated to prioritize non-opioid pain management strategies. After surgery, patients were prescribed ibuprofen and acetaminophen, along with opioid prescriptions that were to be used only if necessary. The opioid prescription was valid for only seven days.

Assessing the Effectiveness of the Initiative

To evaluate the effectiveness of the STOP Narcotics initiative, researchers compared post-operative pain levels of patients before and after its implementation. The study focused on individuals who underwent hernia repairs or laparoscopic cholecystectomies, with findings published in the Journal of the American College of Surgeons.

The evaluation assessed pain levels in 192 patients after the initiative was implemented, comparing them to 224 patients discharged prior to the intervention. Results indicated similar pain levels post-surgery, with a notable decrease in the number of patients requiring opioid prescriptions.

Conclusions and Future Implications

The researchers concluded that the four-pronged strategy effectively reduced the need for opioid prescriptions, thereby minimizing the risk of addiction and preventing unused medications from being misused. They suggested that applying this approach to a broader range of surgical procedures could lead to a significant reduction in opioid prescribing, ultimately contributing to a positive impact on the opioid crisis.

Reference

Hartford L, Koughnett J, Murphy P, et al. Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Non-Inferiority Study to Reduce Opioid Use in Outpatient General Surgical Procedures. J Am Coll Surgeons. 2018. doi:10.1016/j.jamcollsurg.2018.09.008.