Discussing Opioid Use with Dr. Shariff K. Bishai

We know that no demographic is immune to the risks of addiction and dependence. However recent research raises alarms about a particularly vulnerable population: older adults. A report from the U.S. Department of Health and Human Services found that one in three Medicare Part D beneficiaries has received an opioid prescription, with some receiving what is considered extreme amounts of opioids.

To learn more about this group’s thoughts, behaviors and concerns around opioid use, Choices Matter – a national education campaign designed to empower patients to discuss pain management options, including non-opioids, with their doctors – tapped Reader’s Digest to conduct a survey of Americans ages 50 and older.

In an interview with Shatterproof, Dr. Shariff K. Bishai, orthopedic surgeon and advocate for Choices Matter, discusses the survey findings and his approach to reduce the need for opioids following surgery.

Research has found that opioid misuse has doubled among Americans ages 50 and older over the last several years, and Medicare beneficiaries are now the fastest-growing population with diagnosed opioid use disorders. Are patients in this demographic specifically vulnerable to opioid misuse?

While much of the news on opioid addiction and dependence has focused on young adults, it’s true that older Americans are especially vulnerable to opioid misuse. Everyone should be cautious when taking opioid medications; however, older Americans are at increased risk of opioid misuse, largely due to the high incidence of opioid prescribing among this population. Many older adults experience pain related to acute illness or injury, and they are more likely to have chronic disorders associated with pain.

The Seniors & Opioids survey found that nearly 60% of adults 50+ are personally concerned that taking opioids can lead to addiction and dependence, yet nearly half believe people between the ages of 20 and 39 are most at-risk. As an orthopedic surgeon with many older adult patients, these statistics are alarming. It’s important patients recognize that even if a prescription is coming from a doctor, there are risks and side effects associated with medications, particularly opioids. All patients should feel empowered to ask questions and know if a non-opioid option may be available to treat their pain, especially after surgery.

What else did the Choices Matter and Reader’s Digest survey uncover about this demographic’s behaviors and thoughts on opioids?

The survey found that about one-third of seniors who were prescribed opioids keep leftover pills at home, making them available for diversion, which occurs when pills land into the hands of a person other than the prescribed patient. Additionally, while 70% of those surveyed believe opioids are often overprescribed, nearly 40% admit to using their leftover pills for conditions they weren’t originally prescribed to treat. These risky behaviors can lead to diversion or misuse and illustrate the need for greater patient education surrounding proper opioid use and disposal.

What can surgeons do to help mitigate behaviors such as holding on to leftover pills?

Many patients may not even recognize that having leftover pills in the home can unintentionally lead to diversion or misuse. As surgeons, one step we can take to reduce the risk of opioid diversion is to prescribe as few opioids as clinically necessary – or none at all – by utilizing effective non-opioid options. It’s also important that we educate patients about proper ways to dispose of leftover pills. Most local police stations are safe disposal sites where patients can turn in leftover medications. Further, National Drug Take Back Days are held twice a year (April and October) and temporary collection sites are set up around communities so that people can get rid of any old medications, including opioids.

How has the opioid epidemic impacted your prescribing habits?

Knowing the risks and side effects that come with opioid use, I utilize a non-opioid, long-acting numbing medication that is injected during surgery and can provide patients optimal pain control for the first few days following a procedure. Through this protocol, I have reduced my opioid prescribing habits by more than half, and most of my patients report virtually no pain in the days following surgery. This approach also helps limit the unwanted side effects patients can experience from opioids, such as constipation, nausea and dizziness.

The survey found that 82% of respondents agree that patients and doctors need more access to non-opioid options for pain following surgery, suggesting a need for wider availability of these effective alternatives. As non-opioid protocols to manage pain continue to be more widely utilized, we will see a much-needed reduction in opioid exposure among patients of all demographics.

What can patients do if they have concerns about using opioids following surgery?

16 million surgical procedures are performed each year on Americans ages 65 and up, so it’s critical patients speak with their doctors about all available pain management options, including non-opioids. This conversation should be a two-way dialogue prior to surgery and patients should feel empowered to discuss any concerns they may have. It’s important that patients know what to expect throughout the entire surgical process, including how their pain will be managed before, during and after surgery. The Seniors & Opioids survey found that orthopedic surgery is the most feared type of surgery among 44% of seniors. However, learning about effective non-opioid options available to treat pain following surgery, and how these options can help provide a quicker recovery experience, can help mitigate some of this fear.

Are non-opioid options only available for orthopedic procedures?

No, non-opioid options are not limited to just orthopedic procedures. While I have seen great success in procedures such as total knee replacements and shoulder surgeries, there are many other surgeons in different practice areas successfully utilizing opioid alternatives as well. For instance, non-opioid options are used in procedures such as C-sections, plastic surgery, bariatric surgery, wisdom tooth removal and more.

If you or a loved one are planning for surgery, speak with the doctor about what pain management options may be available. Patients can also educate themselves on their choices and prepare for surgery with helpful resources like shatterproof.org/choices-matter.