A group of surgeons in upstate New York has adopted new guidelines for prescribing opioids.
The recommendations, developed by a team convened by Excellus BlueCross BlueShield, aim to reduce excess supply of the drugs in the midst of an opioid epidemic that killed almost 200 people in Monroe County last year.
“In the past, that was the big emphasis: to completely eliminate pain,” said LouAnne Giangreco, who oversees health care improvement at Excellus. “But we’re now starting to understand more that pain sometimes is a necessity in life.”
Efforts to eliminate pain by physicians, and aggressive marketing by pharmaceutical companies, resulted in a generation of people with too-easy access to addictive painkillers, Giangreco said.
Under the new guidelines, she said, many patients will be receiving fewer opioids after surgeries.
“The goal is to reduce the number of unused opiate pills that are out there in the community,” said Giangreco. “The goal is to expose less people to opiate pain medications and to expose them for the least amount of time necessary.”
It’s a virtuous goal, said Monroe County public health commissioner Michael Mendoza.
“They’re trying to right the wrongs of the past,” he said.
Still, Mendoza said, it only scratches the surface.
“The epidemic has moved beyond prescription opioids,” he said. “It has only an indirect effect on the underlying problem of addiction itself.”
And the guidelines are still open to some interpretation. In cases of “extenuating circumstances,” Giangreco said, physicians might still prescribe larger quantities of opioids.
But in general, she said, she wants surgeons and patients to be open to other methods of managing pain, like mindfulness meditation or non-opioid painkillers. And she wants them to understand that surgery is not comfortable.
“Pain is something to be expected after any surgery. There’s no completely pain-free surgery,” Giangreco said.
