History of Substance Abuse and Need Surgery: Now What?
Every patient approaching surgery should be concerned about persistent opioid use, Opioid Use Disorder (OUD), addiction, and leftover prescription medications. One group should have grave concerns—those patients who have a history of Substance Use Disorder (SUD). The Opioid Crisis has now raged on for over two decades. As a result, it is estimated over 20 million Americans have a history of OUD. That’s one person for every 13 adults in the United States!
While these patients have a history of misuse of these powerfully addictive pain medications, thankfully, most are not current users. They are living their lives with that scary chapter tucked away in the past. And then the need for a knee replacement or a hysterectomy or another surgical procedure arises. Now what…?
Surgery has an Opioid Problem
Ninety percent (90%) of patients receive a prescription for opioids after surgery. Further, three out of four patients use opioids in the recovery period after surgery. More than one in five opioid-naïve patients who undergo surgery continue to use opioids three months after surgery.
As a patient with a history of opioid addiction, it can feel as though you have three options:
- Delay surgery, potentially leading to a more difficult and invasive procedure down the road
- Roll the dice on surgery and hope the seemingly unavoidable re-exposure will not be a re-entry to dangerous use
- Avoid surgery altogether—despite pain, harmed quality of life, and other consequences
However, there is a better choice.
Successfully Navigating Surgery to Achieve Better Outcomes
Advances in surgery make better managed pain AND fewer (even no) opioids possible. The keys to a better surgical experience are:
- Enhanced Recovery After Surgery care pathways, which reduce stress on patients before, during and after surgery
- Multimodal pain management, a component of Enhanced Recovery protocols, takes advantage of a combination of non-medication therapies and medications of different types to get ahead of the pain and stay ahead of the pain
If you are a patient with history of Substance/Opioid Use Disorder, become empowered as you consider and prepare for surgery. You can do this by:
- Ask questions of your surgeon that will demonstrate you are an informed patient with reasonable demands
- Directly communicate to your doctor and surgeon that you (or family members) have a history of substance use/opioid use disorder and you wish to explore opioid-sparing pain management protocols
- Ask questions about the post-surgical pain management control plan and repeatedly communicate your concerns about finding a better pain management plan with fewer (even no) opioids
- Inform yourself about multimodal pain management
A New Surgery Model for At-Risk Patients
Goldfinch Health created a health navigator model that combines personalized nurse case management, patient advocacy, Enhanced Surgical Pathways, and leading-edge technology. This ensures patients have access to the best information, surgical approaches and, perhaps most important, support exactly where and when they need it.
This is important for all patients as they approach surgery. It could not be more critical for patients at-risk due to history of addiction.