Declining use of prescription painkillers among preoperative patients seeking joint replacements indicates efforts by the state of Tennessee to tighten the spigot on opioids are beginning to have an impact, according to a study by Vanderbilt’s Andrew Shinar, M.D.
Patients coming to the Vanderbilt Joint Replacement Center who said they took opioids for pain declined 38 percent from 2011-2012 to 2013-2014.
The decrease occurred after implementation of the Tennessee Prescription Safety Act of 2012, which required more stringent reporting and monitoring.
However, addiction remains a major problem in Tennessee, which set a new record for overdose fatalities last year with 1,263 deaths, according to the Tennessee Department of Health.
The incidence rate of 19.3 overdose deaths per 100,000 people increased from 17.9 in 2013 and 16.9 in 2012.
Besides putting people at risk for addiction, opioid prescriptions cause problems for patients needing joint replacements.
“There are many ways to treat knee arthritis medically,” Shinar said. “Most of the time, doctors treat it with anti-inflammatory drugs like Ibuprofen or Tylenol, and occasionally, with narcotics,” Shinar said.
“The problem with treating it with narcotics is that the amount of pain that people have after the surgery is a lot higher if they are on narcotics before the surgery.”
This situation sets up the scenario for serious complications in post-operative care.
“When you get over-sedated, you stop breathing,” Shinar said. “That’s the real scary part of it all. When someone is on narcotics preoperatively, the window between giving so much that they stop breathing and enough to keep them from getting pain is very narrow.”
The use of anti-anxiety medications also decreased among patients, from 18 percent to 11 percent, though this decrease was not statistically significant, Shinar said.
Use of opioids to treat pain decreased from 34 percent to 21 percent, and this decrease was statistically significant.
He presented the findings from his study at the 2015 annual meetings of the Southern Orthopaedic Association and Tennessee Orthopaedic Society.
