Canadian Clinical Trial Shows Significant Reduction in Opioids with OTC Meds at Surgery

Sarasota, FL (WorkersCompensation.com) – In 2020, several states were still above the national opioid prescribing rate of 4.22 percent, according to data from the CMS Opioid Prescribing Mapping tool.

Orthopedic providers are one of the top prescribers of opioids, especially for arthroscopic procedures. Currently, there are around 23,000 licensed and practicing orthopedic surgeons in the U.S., and the number of orthopedic providers is expected to increase. It is estimated that orthopedic surgeons perform more than 1 million shoulder and knee arthroscopic procedures every year.

Some studies have shown the risk of extended opioid use after an arthroscopic procedure is around 8.3 percent. With preexisting pain, previous substance abuse, and mental health issues, the risk increases even more. However, finding an appropriate substitute without addiction risk has been somewhat difficult. Studies have shown that anti-inflammatories can actually impede resolution of back pain, and present a higher risk of heart failure in patients with diabetes. While limited, studies have shown that over the counter nonsteroidal anti-inflammatory drugs can be very effective at managing pain, and in some cases can reduce the need for opioids after surgery.

In a randomized clinical trial that ended earlier this year at three healthcare centers in Ontario, Canada researchers followed 200 patients who underwent outpatient arthroscopic shoulder or knee surgery, with follow up for six weeks during the postoperative period. The goal of the trial was to determine if implementing over the counter medications reduced the consumption of opioids after surgery. 

Patients in the opioid-sparing group received over the counter medications naproxen, acetaminophen, and pantoprazole to address digestive issues. Additionally those patients were given a limited rescue prescription of hydromorphone, and received educational material. The control group received the usual course of care, which included a prescribed opioid analgesic. Researchers reviewed not only opioid consumption at six weeks postoperative, but also evaluated pain levels, patient satisfaction, and adverse events.

Overall, the researchers found that in the opioid-sparing group there was a significant decrease in opioid consumption, as well as fewer medication related adverse effects. Patients in the opioid-sparing group received an average of 40.4 mg of morphine equivalent, compared to 341.2 mg given in the standard control group. In the opioid-sparing group, there were also fewer incidences of headaches, dizziness, and drowsiness. At the end of the six-week period, there no notable difference in pain levels, opioid refills, or satisfaction scores.

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