Two Cincinnati doctors are striving to revolutionize post-operative pain treatment to solve America's prescription drug epidemic. Both agree the best place to start is by looking in the mirror.
The National Safety Council reports
52 people die every day from opioid medications, and 47,000 die every year from a drug overdose, mostly from prescription opioid medications.
Dr. Glenn Waters (right), a partner at Oral & Facial Surgery Associates, routinely treats patient pain related to dental extraction, bone grafting and implants. Dr. Timothy McConnell deals with acute pain as an orthopedic surgeon at Reconstructive Orthopaedics. He also is director of the orthopedic trauma and geriatric fracture program at Bethesda North Hospital.
Waters has worked with McConnell to invent a protocol that already has enabled the two physicians to keep thousands of opioids out of homes in southwest Ohio. Instead of first issuing Oxycodone, Vicodin or Percocet, the two prescribe over-the-counter drugs such as Ibuprofen (Motrin and Advil) and Acetaminophen (Tylenol) to manage patient pain.
"This is the complete opposite of what has become the standard – to maximize the opioid first and ignore non-opioid pain medication," said McConnell. "We have shown that our patients have more than adequate pain control with far less need for opioids."
McConnell knows this to be true because he is writing fewer opioid prescriptions and receiving high marks through unsolicited patient reviews. One said, "The pain control protocol he uses allowed me a virtually pain-free recovery without any narcotics! Amazing!" Another said, "I did not require any opioid pain medications following arthroscopic surgery on my shoulder."
Crunching the Numbers
After implementing the protocol, Waters examined his prescribing data, controlling for identical surgeries, surgical technique and patient interaction, and found his numbers to be "compelling and motivating."
He calculated a 70.4% reduction of opioid pills prescribed (2,736 vs. 9,262) during an eight-month period. At that rate, he expected to prescribe 10,000 fewer opioid pills in his first year using the protocol.
McConnell's experience was similar. He reduced his opioid pills prescribed by 49.7% in the same eight-month trail (5,050 vs. 10,040), and he was on track to prescribe 15,000 fewer opioid pills. Just as remarkable, the two have discovered their patients use less than one-fourth of the opioids they have prescribed.
Another key focus is to teach their patients about risks associated with unwanted opioids and how to dispose of drugs in drop-box locations. Data shows four out of five heroin addicts start out abusing prescription opioids.
The two doctors even have designed a mobile app to supplement their protocol. Waters says the app, still in the production stages, could be a game-changer since many younger patients are so connected to mobile technology.
Weighing Risks and Rewards
Waters and McConnell are aware of research that shows
ibuprofen may increase the risk of heart attack and that some patients cannot handle Tylenol. Neither wants to push those concerns aside. Yet, both push for a better understanding of how these types of medications play a role in effective acute pain control.
"For a generation of prescribers, the potential negative impact of opioids has been under-appreciated and the contribution of non-steroidal anti-inflammatories and Acetaminophen undervalued," Waters said.
Today, he and McConnell are like brothers in arms. Focused on their surgical practices by day, they make time after hours and after their families are asleep to advance their protocol. Both credit physical activity and a healthy lifestyle for helping them summon extra energy.
They share a common bond having competed in California at the CrossFit Games and thriving at SEALFIT's 60-hour Kokoro boot camp training experience.
"Mental toughness," McConnell said. "It's hard to beat somebody who doesn't quit."