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NH surgeon offers opioid-prescription guidelines to try to help curb opioid crisis

Union Leader Correspondent

December 26. 2017 12:33PM
Dartmouth-Hitchcock's Chief of Surgery Dr. Richard Barth is offering surgeons specific guidelines for post-surgery prescriptions for pain-relieving opioids. (COURTESY)

LEBANON — Based on his latest study, Dartmouth-Hitchcock’s Chief of Surgery Dr. Richard Barth is offering surgeons specific guidelines for post-surgery prescriptions for pain-relieving opioids.

Barth said as a surgeon he wanted to see if there was something he could do to curb the opioid crisis.

Many states, including New Hampshire, have adopted laws that prohibit doctors from prescribing more than a seven-day supply of opioids — but a seven-day supply can range from 20 pills to 80 pills, Barth said.

“I know I prescribe opioids for patients that I operate on I was just wondering if I could do that better and optimize that and help to diminish this epidemic,” Barth said. “The Surgeon General has said if doctors keep prescribing more pills than are actually needed, then this crisis is going to go on unabated.”

The study was published in the Journal of the American College of Surgeons on Dec. 15 and is based on a series of studies Barth conducted at Dartmouth-Hitchcock.

According to the peer-reviewed Journal article, this is the first time specific guidelines have been proposed for prescribing opioids after surgery patients are discharged from the hospital.

The studies took a look at patients who did not have issues with chronic pain, and so were not on opioid medications on a regular basis.

The first study examined outpatient surgeries and found that a regimen of acetaminophen and ibuprofen could control 85 percent of post-surgical pain. This regimen resulted in a 53 percent reduction in opioid use by surgical outpatients.

In another study, Barth found that when surgical patients are released from the hospital, they usually take the same dosage of an opioid at home that they were given on the last day of their hospitalization.

Barth said the study tracked what the patient was prescribed by their surgeon upon release from the hospital and then followed up with the patient with one question: How many pills were actually used?

The study found patients used only about a quarter of the pills they were prescribed, Barth said.

He said surgeons don’t mean to overprescribe, but are thinking about the comfort of their patients.

“Most doctors want to make sure their patients were pain-free and didn’t have to come back,” Barth said.

However, left-over pills in patients’ homes can lead to abuse by the patient, someone else in the household or an addict who can gain access to the pills, he said.

Barth believes these guidelines will be adopted by doctors because they like to act on evidence.

“If people use our guidelines, it will remarkably decrease the amount of opioids prescribed by about 40 percent compared to standard prescribing,” Barth said.

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