Friday, August 26, 2016

Opioid guidelines: Mass General responds

In early July, the Mass General/MGPO Opioid Task Force launched a set of new guidelines for the safe and effective prescribing of opioids in the settings of acute and chronic pain. These guidelines were created to comply with new state requirements and as a way for Mass General to continue to address the opioid epidemic. Now in place for nearly two months, Mass General clinicians share their thoughts on the guidelines and the future of substance use disorder care.

For all our patients, we utilize non-narcotic alternatives for pain first, appropriately limit the number of pills prescribed when narcotics are necessary and after prescribing, ask and educate about and actively encourage disposal of unused pain medications.

— Jeffrey Ecker, MD, chief, Department of Obstetrics & Gynecology

For orthopedic surgeons, these guidelines are especially crucial. Balancing patient comfort with narcotic use risks in the setting of acute and chronic injury or surgery is a constant struggle, and having a policy in place that helps guide decision-making will benefit both doctors and patients tremendously.  We anticipate that this current policy and future policies will inform and protect patients, limit overprescribing and reduce the amount of unused narcotics in the community. 

­— A. Holly Johnson, MD, foot and ankle surgeon in the Mass General Department of Orthopædic Surgery 

Each day, we see patients with opiate use disorders. It’s our job to prevent further misuse by not prescribing more narcotics. These new guidelines give us a framework for how to avoid doing so without just saying “no, we can’t help you.” Instead, we’re giving patients resources and working with them to help find appropriate treatment. For those not ready to stop, we provide nasal naloxone to help treat future overdoses. We teach patients – and their friends and family – how to use the medication and we have already seen it save lives.  

— Ali S. Raja, MD, vice chair of the Department of Emergency Medicine 

The new guidelines are vitally important in setting out principles of safe and effective opioid prescribing for primary care doctors. At the MGH health centers, we experience the devastating effects of opioid use disorder first hand and anticipate the new guidelines will help our clinicians work in sync to better monitor our patients on opioid therapy while keeping our communities safer. 

— James Morrill, MD, chief of Adult Medicine, Mass General Charlestown HealthCare Center

Incorporating these standards when counseling patients increases the safe and effective use of opioids, particularly for patients who are receiving the medication for the first time. It’s our job to work together with other clinicians to manage patient needs while ensuring safety.

— Karen M. Ryle, RPh, associate chief of Pharmacy

An acute hospitalization is an opportunity to address substance use issues and forge relationships with resources that heighten the likelihood of an addict’s success. The new guidelines prompt inpatient providers to check the data bases to determine patient’s drug use history, screen patients for abuse risk, and proactively consult the pain service and Addiction Consult Team so that vulnerable patients have a holistic approach to managing pain and addiction post-discharge.

— Patti Fitzgerald, RN, nurse director, Bigelow 11

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