Roswell Park Comprehensive Cancer Center will start a new opioid-sparing treatment policy after a two-year study suggested that pain after surgery can be just as effectively managed with little or no narcotic painkillers.
The study, published earlier this month in JAMA Network Open, outlines the results of a multidisciplinary team of surgeons and other cancer specialists at Roswell Park who drastically reduced opioid use with patients without negatively affecting pain scores, postoperative complications or patient requests for additional opiate painkillers.
Study participants included patients who underwent gynecologic or abdominal surgery and were prescribed fewer opioids at discharge. During the first year alone, the protocol eliminated the circulation of 16,374 opioid tablets (5 mg oxycodone equivalent). The results of the full study, in 1,231 patients, demonstrated that because postoperative pain can be managed effectively without opioids for minor or minimally invasive surgical procedures – or with only a three-day supply for major surgery – the risks of chronic opioid misuse can be managed by reducing or eliminating opioid prescriptions in the first place.
Roswell Park officials said they believe the cancer center is the first of its kind in the U.S. to implement such a policy so broadly. The change is expected to reduce health care costs while protecting patients and the greater community from the risks associated with opioid use.
In 2016, to combat the opioid crisis, New York State began limiting opioid prescriptions to a seven-day supply for acute pain. However, pain associated with cancer treatment is exempt from this rule, leaving the decision to the treating physicians, who currently have no clear guidelines on the amount of opioid pain medications needed after cancer-related surgery.
“Nearly all of my patients would call to ask what to do with their leftover pain pills,” said Dr. Emese Zsiros, assistant professor of oncology with Roswell Park’s Department of Gynecologic Oncology and Center for Immunotherapy and senior author of the new study. “I didn’t have a clear answer for them, as these medications are difficult to dispose of, and you don’t want them sitting in an unlocked medicine cabinet, where family members or friends can easily access them.”