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QHC surgeons ‘Cut the Count’ to help with opioid crisis

Maybe it starts with a prescription of Tylenol 3 to help you through a back injury, or perhaps it’s a prescription of Hydromorphone after surgery. Opioid addiction is a growing problem in North America and can begin with something as simple as a prescription of pills meant to help you cope with acute pain.

Prescribing opioids to manage pain is a common practice across North America. Canadians are the second largest per-capita users of prescription opioids after the U.S.  Sadly, every day in Canada, an average 11 people die of opioid overdose.

Ontario’s surgical community recognizes the important role surgeons can play in reducing opioid-related harms. If patients are prescribed more pills than they need at discharge, they may end up taking many or all of them and developing a dependency. Or, if they don’t take all the pills prescribed to them—which studies show is often the case—this can add to the supply of opioids in the public domain that may be used inappropriately.

QHC is part of Health Quality Ontario’s ‘Cut the Count’ campaign to reduce the number of opioid pills we prescribe to surgical patients at discharge. The goal of the 47 hospitals involved in the campaign is to reduce the number of opioids prescribed after surgery by 30% from April 2019 to March 2020.

Quinte Health Care is off to an amazing start! So far, four surgical divisions at Belleville General Hospital (General Surgery, Orthopedics, Gynecology and Urology) have made changes to their standard post-surgical prescriptions for many procedures and have reduced their narcotic prescriptions by 36%.

This was achieved by:

  • Educating health care providers – including surgeons, who often prescribe more opioids than their patients actually need.
  • Surgical divisions looked at what surgeons currently prescribe and came to a consensus on a new, multimodal post-operative prescription that includes more acetaminophen and Ibuprofen and smaller prescriptions of opioids, only to be filled if required.
  • Prescribing split prescriptions of opioids that only permit the patient to pick up a small number of pills from the pharmacy at a time. Then returning for more, if necessary.
  • Anesthetists have altered the narcotics given to the patient during surgery to help decrease the pain patients are in afterwards.
  • Educating patients about the dangers of opioids and helping them understand that some pain after surgery is normal. Zero pain isn’t the goal – tolerable pain that allows patients to complete daily activities is the goal. This education is happening with all surgical patients at BGH and TMH.
  • Encouraging patients to return unused opioids to the pharmacy so they’re not sitting in medicine cabinets or making their way to the streets.

“The surgeons have been very keen to participate,” said Kristina Cruess, QHC’s Program Director of Surgery. “The opioid crisis cannot be ignored. QHC’s surgeons are taking an active role in reducing the number of opioids available in our communities. I am very proud that the Surgical Program supported this initiative as one of our 19/20 goals.”

Studies have shown that when reducing the opioids prescribed post-surgery, patients are just as satisfied with their pain control. And with the increased education about the potential hazards of opioids, patients are less likely to fill their opioid prescriptions. When they do fill their opioid prescriptions, patients take fewer pills.

“Congratulations to the surgical team on making strides with this excellent initiative to reduce the number of opioids available in the community,” said Jeff Hohenkerk, QHC Vice President. “This is definitely a success story!”