Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
BJU Int. 2018 Nov;122(5):754-759. doi: 10.1111/bju.14446. Epub 2018 Jul 26.
Opioid abuse and addiction is causing widespread devastation in communities across the USA and resulting in significant strain on our healthcare system. There is increasing evidence that prescribers are at least partly responsible for the opioid crisis because of overprescribing, a practice that developed from changes in policy and reimbursement structures. Surgeons, specifically, have been subject to scrutiny as 'adequate treatment' of post-surgical pain is poorly defined and data suggest that many patients receive much larger opioid prescriptions than needed. The consequences of overprescribing include addiction and misuse, dispersion of opioids into the community, and possible potentiation of illicit drug/heroin use. Several solutions to this crisis are currently being enacted with variable success, including Prescription Drug Monitoring Programmes, policy-level interventions aimed to de-incentivize overprescribing, limiting opioid exposures through Enhanced Recovery After Surgery protocols, and the novel idea of creating surgery- and/or procedure-specific prescribing guidelines. This problem is likely to require not one, but several potential solutions to reverse its trajectory. It is critical, however, that we as physicians and prescribers find a way to stop the needless overprescribing while still treating postoperative pain appropriately.
阿片类药物滥用和成瘾正在美国各地的社区造成广泛的破坏，并给我们的医疗保健系统带来巨大压力。越来越多的证据表明，由于过度处方，医生至少在一定程度上对阿片类药物危机负有责任，这种做法是由于政策和报销结构的变化而产生的。具体来说，外科医生受到了审查，因为术后疼痛的“充分治疗”定义不明确，而且数据表明，许多患者接受的阿片类药物处方远远超过了所需剂量。过度处方的后果包括成瘾和误用、阿片类药物在社区中的扩散，以及可能增强非法药物/海洛因的使用。目前正在实施几种解决这一危机的方案，但效果各不相同，包括处方药物监测计划、旨在抑制过度处方的政策层面干预措施、通过增强手术后恢复协议限制阿片类药物暴露，以及创建针对手术和/或手术特定的处方指南的新想法。这个问题可能需要不止一个，而是几个潜在的解决方案来扭转其发展轨迹。然而，至关重要的是，我们作为医生和处方者，必须找到一种方法，在适当治疗术后疼痛的同时，停止不必要的过度处方。
