The state of Michigan has succeeded in reducing prescribed opioid use by one-third after seven months of implementing new post-operative prescription medical protocols.

The Michigan Surgical Quality Collaborative (MSQC) is a statewide, collaborative quality improvement project that keeps a clinical record of general, vascular, and gynecologic surgical procedures, collecting a random sample of 50,000 patients per year.

 The aim of this program is to develop and disseminate post-operative prescribing practices and to measure the effect of these prescriptions.

Opioids are widely prescribed after surgery, and leftover drugs are often diverted to society, the authors of the program explain in the New England Journal.

Over the past few years, many studies have shown that a side effect of these postoperative opioid treatments was a long-term dependence on these drugs, which has led to a severe opioid epidemic in the United States.

Just six months after arriving at the White House, President Donald Trump declared the opioid crisis a national public health emergency under federal law and ordered a report to analyze the origins of the crisis, the distribution channels for this drug, both legal and illegal, and the actions needed to overcome the problem.

And among the actions proposed by the report to overcome this crisis are the promotion of good practices in the prescription of opioids, the creation of programs for monitoring prescriptions, and education of providers and physicians.

“We performed an analysis to compare the postoperative prescription of opioids before and after publication of the guidelines,” the scientists explain.

A survey of 12,000 patients in 43 hospitals that followed the protocol revealed that when opioid administration was reduced, there was no decrease in patient satisfaction when it came to pain.

Doctors prescribed eight fewer pills per patient, down from 26 to 18, in nine common surgical procedures, a reduction of nearly one-third.

“We’re not trying to deny patients narcotics,” said Dr. Joceline Vu, one of the paper’s authors and a general surgery resident at the University of Michigan, according to the media.

“But there’s an acceptable level where people are still happy and still have their pain under control, but we have dropped the number to a minimum,” she said. 

More than 130 people die every day from opioid overdoses in the United States, said the U.S. National Institute on Drug Abuse (NIH).

“The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare,” says the government agency.

In the late 1990, pharmaceutical companies assured the medical community that patients would not become addicted to prescription opioid painkillers, and healthcare providers began prescribing them at higher rates, the NIH explains.

In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin and illicitly manufactured fentanyl, a powerful synthetic opioid.

 What are opioids?

The opium poppy is a medicinal plant used by ancient civilizations. It mitigates pain, elevates mood, has relaxing effects, and attenuates stress, melancholy, and anxiety. With the dawn of modern chemistry in the early 1800s, morphine, codeine, and the baine began to be manufactured from the opium poppy, Papaver somniferum.

Scientific curiosity or the optimization of medicinal properties led chemists to synthesize variations of these natural opioids. And the final products included heroin, oxycodone, oxymorphone, hydrocodone, hydromorphone and others.

To avoid dependence on the opium poppy plant for opiates, new compounds such as methadone, meperidine, fentanyl, tramadol, U47700, were later created. These drugs were structurally distinct from morphine, but targeted at the same pain reduction/pleasure induction receptors and circuits as the naturally derived analogues of plants, such as morphine.

Susceptible individuals, both medical and nonmedical users, discovered the euphoria producing properties of potent opioids when administered rapidly in the brain, especially when smoked or injected.

Names of some of the most commonly prescribed opioids

Opioids are a class of drugs that includes everything from heroin to legal prescribed painkillers such as oxycodone, hydrocodone, codeine, and morphine.

– Fentanyl – 50 times more potent than heroin

– Hydrocodone

– Oxycodone

– Hydromorphone

– Oxymorphone

– Buprenorphine

– Tramadol

– Methadone

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