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Category: December 2018

The overdose crisis has found its way into our operating rooms and our homes alike. Hand surgeons recognize the dire need for action. For December, we asked our members how they have personally modified their pain management protocols to address this devastating issue.

No More Pressure to Prescribe

By Ilvy H. Cotterell, MD When I was a resident, I recall prescribing upwards of 50 pills of narcotics for routine soft tissue procedures, as this minimized the likelihood of a phone call that night from the patient for pain related questions.  At that time, I did not consider the potential for actually doing harm […]

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Arguing the Causes and Bearing the Guilt

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 […]

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We Are on the Front Lines

By Benjamin R. Graves, MD Whether we’re aware of it or not, Hand and Upper Extremity surgeons are on the front line of the opioid crisis.  As practitioners of musculoskeletal medicine, we aim to improve our patient’s quality of life with surgery, and occasionally, prescriptions for pain medications.  During the past few years a wave […]

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Tiers for Post-Op Prescriptions

By Dan Mass, MD Our group has created a uniform way to attack the Opioid Crisis.  All elective cases sign consents for surgery and our nurses have them sign a drug use understanding.  We do not allow residents to renew narcotics.  We also use tiers for post-op prescribing.  They are: Tier 1: Tylenol 500 mg (qty: […]

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It Is Our Duty

By A.J. Mencias, MD On 7/26/17, one of my best friends and partners, Dr. Todd Austin Graham, was murdered by the husband of one his patients over an argument about prescribing pain medications to the patient. Dr. Graham had only had a couple of visits with the patient. He had only begun the treatment process.  The […]

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Turning the Tide

By Nicholas Pulos, MD I was fortunate to train as our profession’s and the public’s perception of pain management was changing for the better. As an intern, I rounded on hip and knee patients prescribed morphine PCAs post-op. I remember my mentors telling patients (erroneously) that the risk of opioid addiction was low because they […]

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Assess Your Prescribing Practices (and Compare to Your Colleagues)

By Melissa Young Szalay, MD The Hand Surgery section of my Orthopaedic group has been in front of the curve in terms of addressing potential over-prescribing of opioids after surgery. My partner, Dr. Jeffrey Rodgers, was a co-author of a study that evaluated postoperative pain control and quantified the amount of leftover pain medication (“Opioid consumption […]

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