Doctor Pushes for Prescribing Changes

Surgeon has Change of Heart About Prescription Painkillers

Trip to a Third World country brings doctor new insight into the use of opioids to treat pain.

American surgeon Corydon Siffring landed in Uganda in December 2015, three days after his friend's 16-year-old son underwent a seven-hour surgery to remove his spleen, repair damage to his left orbital eye mechanism and reconnect six tendons in his left hand.The boy had been stabbed.

Dr. Siffring, professor at East Tennessee State University's Quillen College of Medicine and member of the surgical trauma team at Holston Valley Medical Center in Kingsport, found him hooked to a ventilator and resting in bed with an opioid infusion to treat his pain.

"A normal course," Siffring said.

But then Siffring witnessed something unfamiliar to most U.S. doctors. After consulting with an on-site physician, Siffring assisted as the boy was weaned from the ventilator and taken off opioids. He was transitioned to an IV drip of Tylenol, ibuprofen was added later – and the boy was OK.

If he hadn't seen it with his own eyes, Siffring might not have believed it possible to adequately treat a post-operative trauma patient with Tylenol.

From Skeptic to Believer

Four months earlier, Siffring and a colleague sat in the back of the room at a Sullivan County Safe Communities America seminar in Kingsport. Siffring said the two rolled their eyes as then-NSC Medical Advisor Dr. Don Teater spoke about treating post-operative pain with ibuprofen and Tylenol.

"I made some comments that were fairly caustic," Siffring said. "I told people, 'OK, that may be fine for chronic back pain, but I'm treating people with real pain.' "

He apologized to Teater the next time their paths crossed. Today, Siffring works with NSC to alter physician prescribing habits and break down cultural barriers to behavioral change in the U.S.

Pushing for Change

Americans consume 80% of the world's opioid supply. Siffring is doing his part to change that number. He has submitted a proposal to the Pharmacy and Therapeutics Committee at Holston Valley for liquid acetaminophen to be readily available in post-op care.

Next on his to-do list is addressing consumer-driven doctor rating systems. While intended to help patients make informed decisions before receiving treatment, Siffring says they are flawed and need to be overhauled. Many patients expect to leave a doctor's office with a prescription for opioids. If they don't get it, they often go online and give their doctors a poor rating, he said.

"Maybe we find a way to ask some questions and ferret out … people (who) say, 'I didn't get all the drugs I wanted,' " he said. "One of my partners once said, 'I'd be starving if I didn't (prescribe opioids).' "

Doctors Change Protocol

Dr. Timothy McConnell (left) and Dr. Glenn Waters of Cincinnati are revolutionizing post-operative pain treatment.

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