Awareness of substance abuse in orthopedic patients: a survey of orthopedic surgeons

Attitudes and Knowledge Regarding Pain Management and Addiction in Massachusetts: A Mixed Methods Study on Podiatric Residents

BACKGROUND

The opioid epidemic has hit disastrous levels across the United States. Many attempts have been made to counteract this, including policy changes and modification of provider and patient behavior. The purpose of this study was to understand the current state of podiatric residents' knowledge regarding pain management and addiction.

METHODS

This study used mixed quantitative-qualitative methods. Two focus groups were conducted with two podiatric residency programs to understand current issues and inform the creation of a survey. A 30-question survey was created and peer reviewed to assess general pain management knowledge, levels of confidence in pain management and addiction, and areas for improvement.

RESULTS

Pain management education in podiatry is mainly focused on opioids. These concepts are often taught in a nonstandardized method, which does not often include nonopioid alternatives. Knowledge of risk factors for addiction was lacking, whereas knowledge of behaviors concerning for addiction was more bountiful. Thirty-three surveys were completed of a possible 39. A knowledge score was created from eight survey questions for a total of 10 points, with an average score of 4.61. There was no statistical difference between those with and without a pain management rotation. Nearly all residents felt comfortable managing surgical pain. The residents are "never" or "only occasionally" inquiring about risk factors for addiction. Questions asked also suggest that the residents are not thinking about their role within the opioid epidemic.

CONCLUSIONS

As the opioid epidemic grows, it is imperative to examine the causes and solutions to the problem. Focusing efforts on educating resident physicians is one method to address the issue. The results of this study show that pain management basics need to be reinforced and more time must be spent emphasizing the importance of thorough patient histories and educating patients when prescribing pain medication.

Opioid Use Disorder in Dental Patients: The Latest on How to Identify, Treat, Refer and Apply Laws and Regulations in Your Practice

Opioid use disorder is a persistent problem in the United States and has become an important issue to medical and dental professionals. Americans are the largest users of opioids by a large margin. The importance of knowing how to identify, handle, refer, and treat patients with opioid use disorder cannot be understated. This article attempts to educate dental professionals on the current epidemiology of opioid use, explain the physiology of addiction, teach practitioners how to identify chronic opioid users, gives options for treating dental pain, establishes criteria for referring to an addiction specialist, and describes the laws, regulations, and resources available to practitioners. With this article, practitioners should have a greater understanding of the current problem of opioid use disorder and be able to develop a protocol for treating these patients.

Misuse of Opioids in Orthopaedic Postoperative Patients

OBJECTIVE

In light of the recent uptrend in the prescription of opioids, this study seeks to identify patterns of opioid misuse among orthopaedic postoperative patients and principal external sources in obtaining these medications.

DESIGN

Ten-month survey-based study.

SETTING

Two Level I trauma centers (urban and suburban).

PATIENTS/PARTICIPANTS

Two hundred seven patients between the ages of 18 and 89 years who underwent surgical fixation of fractures involving the pelvis, long bones, or periarticular regions of the knee, ankle, elbow, and wrist.

MAIN OUTCOME MEASUREMENTS

Patients who believed they were undermedicated, used prescribed opioids at higher than recommended doses, and took extra opioids in addition to their prescribed analgesics were analyzed by age, employment, income, education, controlled substance use, pain interference with activities of daily living, and anatomic surgical site.

RESULTS

One hundred eighty-two patients completed the survey; 19.2% of patients (n = 35) felt undermedicated [unemployed (P < 0.05), low income (P < 0.05), and self-reported controlled substance users (P < 0.05)]; 12.6% of patients (n = 23) admitted to using pain medications at a higher dose than prescribed [unemployed (P < 0.05), lower income (P < 0.05), nonhigh school graduates (P < 0.05), and previous controlled substance users (P < 0.05)]; 9.3% (n = 17) admitted to using external opioids [unemployed patients (P < 0.05) and self-reported controlled substance users (P < 0.05)]. Major sources of extraneous opioids include family/friends (n = 5) and other doctors (n = 4).

CONCLUSION

Unemployed and lower-income patients were significantly more likely to believe that their surgeon was not prescribing them enough pain medications as well as use their prescribed opioid medications at a higher than recommended dose compared with their employed counterparts with higher incomes. Unemployed patients were also significantly more likely to use additional opioid analgesics in addition to those prescribed to them by their primary surgeon. Surgeon awareness of a patient's socioeconomic background and associated risk of opioid misuse is crucial to prescribe the safest most effective pain regimen.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Understanding addiction: the orthopedic surgical perspective to a significant problem

The realm of addiction and addiction medicine is one in which physicians receive little formal training, particularly in surgical subspecialties. This article presents an overview of addiction medicine and treatment, concentrating on the neurophysiology, psychological aspects, and terminology. Assessment tools and objective findings for recognizing addiction in patients in pain are discussed, as is the management of acute pain and perioperative considerations for patients who are undergoing opioid treatment programs.

The feasibility of a new intake routine to assess substance use disorders by means of a structured interview

A structured interview, ADDIS (Alkohol Drog Diagnos InStrument), designed to assess substance use disorders, was included as a part of the intake protocol in a department of orthopedics at a general hospital. To evaluate both the effectiveness and feasibility of the new procedure, the attitudes of 29 staff members were sampled during follow-up interviews. In addition, a questionnaire was sent to 254 patients to examine their opinions about the interview. The staff made a global evaluation of the new routine on a 10-point scale, ranging from completely negative (1) to completely positive (10). The mean rating was 8.2 (range 5-10). The evaluations made by the staff members in the interviews were very positive. Of the 254 patients, 177 (70%) returned the questionnaire. More than 90% of the patients appreciated being asked about their use of analgesics and sedatives, and 77% felt it was positive to be asked about their alcohol use. The result of the patient questionnaire supports the feasibility of the routine, suggesting that a structured interview can be included in the intake protocol in order to improve the assessment of substance use disorders.