Post-op Pain Treatment

Ohio Doctors Prescribe a Solution to Opioid Epidemic

  • Surgeons Glenn Waters and Tim McConnell have been on a mission to optimize patients' acute pain control. Over the past two years, they bucked the status quo by adopting a protocol that greatly reduces the number of opioids prescribed to their patients.

    Turning Off the Faucet 

    Imagine a faucet blasting water into a sink and overflowing onto the floor. The water represents opioids being dispensed at an excessive rate, and attempting to soak up the flood with sponges represents the response to the opioid epidemic. Waters and McConnell are adamant that prescribers can turn down the faucet flow and proactively offset the magnitude of the clean-up.

    These doctors have proven they can decrease their flow rate by 74%, and so can others. It has been nearly two years since the two Cincinnati physicians introduced their protocol for treating acute pain with ibuprofen (Motrin, Advil), acetaminophen (Tylenol) and low-dose oxycodone strictly as needed. In that time, they have won over patients, gained support of local business and community leaders and achieved acclaim through word-of-mouth testimony and media exposure.

    After examining data collected during a one-year period ending in November 2016, the two doctors found they prescribed 41,850 fewer opioid pills than the previous 12 months. But the real measure of their success is that five Cincinnati-area emergency rooms have adopted their pain treatment protocol, resulting in 23,110 less opioid pills dispensed in the weeks since inception. Furthermore, two additional ER's have inquired about following suit.

    "Change is often difficult, requiring a willingness or impetus to get outside one's normal behavior or thought process," Waters said. "If five ER's in our community can adopt the protocol, then the same can happen in yours. Why is this important? For front-line, opioid prescribing surgeons, now there's an integrated acute pain solution available to actually help reverse America's opioid crisis."

    Keeping Opioids Out of the Community

    Ohio is at the epicenter of the crisis. Eight people die every day in the state from an opioid overdose – more than anywhere else in the U.S.

    McConnell is an orthopedic surgeon and director of the orthopedic trauma and geriatric fracture program at Bethesda North Hospital. Waters is an oral and maxillofacial surgeon who treats pain related to dental extractions, bone grafting and implants.

    They describe themselves as long-time masters of causing acute pain and, more recently, masters of effectively treating it – while potentially benefiting their communities.

    At the end of the first year using their protocol, Waters examined his prescribing data, controlling for identical surgeries, surgical technique and patient interaction. Findings showed he:

    • Reduced opioid pills prescribed by 74% (3,691 vs. 14,221)
    • Put 10,530 fewer opioid pills in the community and environment

    McConnell's results showed:

    • He prescribed 75% fewer opioid pills and prevented 31,320 pills from entering the community
    • The average number of 5 mg oxycodone pills used per patient was 10

    What becomes of any unused drugs is of the utmost importance, McConnell said.

    "We are constantly reminded of the importance of our role in our patients' education when we discover how many of our patients aren't aware of medication disposal options," he said. "Furthermore, they are naïve about the dangers of leaving unused opioids in their homes, ultimately playing an indirect role in drug abuse."

    Data shows four out of five heroin addicts start by misusing prescription opioids, and more than 50% of people who have abused prescription painkillers report getting them from friends or relatives.

    Empowering Prescribers and Patients

    The two doctors are grounded by their mission: prescribing change and making sure doctors and patients are aware of the protocol that has empowered their patients and community.

    Dee Watson, CEO of Working Partners, posed this question in a BIZ Tips Newsletter: "What if half of the prescribing practitioners in Ohio (40,000) could match the results of these two surgeons?"

    The work of Waters and McConnell also has been featured in Pharmacy Times and on a news program in Cincinnati. Waters said it was a National Safety Council article that propelled their message nationwide.

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