By Aaron M. Freilich, MD

I live and work at the edge of one of the areas worst hit by the opioid epidemic. In the foothills of the Blue Ridge, death from opioid overdose has become a household term.  As surgeons, we are on the front lines.  We can argue about the causes, but, we certainly bear some share of the guilt.  We wrote hundreds, thousands, of opioid prescriptions, many of which played a role in patients’ addictions. Some of it was altruistic, not wanting our patients to needlessly suffer or have poor outcomes due to lack of ability to participate in rehab.  Some of it was expedient, defensive medicine in a way. We didn’t want the 3 am call from a nurses about how the “5^th vital sign” was not being addressed and pain was still an 11 out of 10. Or the call from a patient just a few days after surgery needing a refill because it was all gone.  Fear was rampant, fear that not providing enough medication would drop your patient satisfaction scores, and that would piss off both the bureaucrats and the “internet”.  Things have certainly changed.  There are new state rules regulating amount and duration for a prescription, giving us convenient cover.  The expectations of patients have changed also; it is easier to say no or that it is not necessary at this time or try something else. Interestingly, patients get it and very few complain, even those who might have been labeled as “drug seeking” before.  It doesn’t seem to have affected satisfaction scores or ability to participate in rehab either.  We talk about medicine changing sometimes with the ebb and flow of the tides of time.  Change comes slowly…until it doesn’t.