- Monday, April 9, 2018

There is a major problem that has arisen over the past 15 years with opioid dependence and overdose here in America. This is a multifactorial problem involving unethical opioid prescribing, misuse of prescription medication, and illicit opioid use. A national emergency was declared by President Trump regarding the opioid epidemic.

This is a preventable problem, but evidence shows a continuing rise in overdose deaths. This article will give an overview of opioid dependence and overdose in America and how it is being addressed on multiple levels nationally, statewide and among individual communities and providers. Finally, we will discuss how SonoSpine is cognizant of the national epidemic and how we are impacting our community and reducing opioid dependence.

The Centers for Disease Control and Prevention (CDC) reports that in 2016 overdose deaths increased to five times that in 1999. (1) Some 600,000 people died from drug overdose from 2000 to 2016. In 2015 alone, over 33,000 Americans died due to opioid overdose, and it is reported on average that 115 Americans die daily from opioid overdose. (3)

In comparison, the prescribing of opioids has also increased from 1999-2014 and has been reported at quadrupling in this time frame. (1) Prescribing rates increased from 72.4 to 81.2 prescription per 100 persons between 2006-2010, were constant between 2010 and 2012, and later declined to 70.6 per 100 persons from 2012-2015, a 13.1 percent decline. (2) In 2015, the number of opioids prescribed was three times higher than that of 1999, and when compared to Europe is four times higher than their prescribing rates during that same year. (2)

Opioid dependence and overdose is a problem affecting all socioeconomic groups and is being addressed on multiple levels from national to individual providers. Having the opioid crisis labeled as a national emergency will allow programs to be implemented and funded to combat this crisis. Education has been instituted through the U.S. Drug Enforcement Administration to inform physicians and providers about judicious use of opioids and consideration of multimodal approach to pain management.

U.S. legislators are working on reducing the supply of illegal drugs on the streets from Mexico and China, the two largest suppliers of heroin and fentanyl, respectively. (4)

Hospitals and providers are taking steps in implementing systematic guidelines. These include nonpharmacological options, discussing risks of opioids with patients, use of Prescription Monitoring Programs, and education on how to wean off opioids along with using a multimodal approach for pain management. (5)

Providers are now looking at opioid dependence as a disease state, thus helping decrease the stigma of the abuse while increasing efforts to facilitate treatment measures. There are still considerable barriers to treatment, which include cost, availability of facilities, and limited access to providers and programs.

Being a provider within a neurosurgical practice, I am very aware of the risks of developing chronic pain due to pain that is not treated appropriately and also after surgical interventions, especially lumbar fusions. When I first viewed a lumbar fusion while working for an orthopedic spine surgeon before joining SonoSpine, my thought was that this surgery was barbaric. Why would anyone want their facet joint removed for decompression of the nerves and then have screws and rods placed in their back? This is supposed to help with their pain?

This physician felt the same way — that lumbar fusion surgery was barbaric as well.

The success rate of lumbar fusion nationally is 60 percent to 70 percent, as reported by SpineUniverse.com. This leaves about 30 percent to 40 percent of patients at high risk of developing chronic pain and at risk of contributing to the problem of opioid dependence.

There is now another option: SonoSpine.

I am grateful to work for a neurosurgeon who is a forethinker and trailblazer for the area of spine surgery. Ultrasonic surgery through SonoSpine helps patients avoid fusion. Dr. Dilan Ellegala has perfected the technique and tool to perform a minimally invasive surgery that is also minimally disruptive and allows for avoidance of lumbar fusion in most cases.

We have developed techniques to help reduce pain during surgery and postoperatively. We use an intraoperative Exparel cocktail that gives patient immediate relief of pain in the incisional area. Over a three-month period, immediate postoperative pain scores with use of Exparel cocktail were accumulated. This retrospective analysis showed that patients had an average pain score of 2 on a pain scale of 1-10. The use of Exparel has benefited patients with less narcotic use and better pain control following surgery.

On average following surgery, patients are on narcotics no longer than two weeks. We initiate pharmacological and nonpharmacological pain-management strategies including anti-inflammatories, muscle relaxers, ice, heat, and limited activity. Physical therapy that includes paraspinal muscle strengthening four weeks post-op is imperative for each patient. Walking is encouraged the day of surgery and then recommended to increase in an incremental fashion each week.

We discuss the importance of daily activity with set limitations. Patients are able to return to work sooner and regain the lifestyle they enjoy. This surgery has brought quality of life back to so many patients. They are able to return to activities they love. SonoSpine is an amazing innovative surgical option to avoid fusion, reduce risk of chronic pain, and allow the use of limited narcotics in order to give patients’ back their lives.

Virginia Kelli Rosas, RN, MSN, FNP-C, holds a Masters in Nursing from Vanderbilt University School of Nursing and is certified in Family Practice. She has been working with patients with acute and chronic spine disorders since 2006.

1 Centers for Disease Control and Prevention. (2017, August 24) Opioid Basics: Understanding the Epidemic, Opioid Overdose. Retrieved from https://www.cdc.gov/drugoverdose/data/index.html.

2 Schuchat A, Houry DE, Gery Jr GP. (2017) “New data on opioid use and prescribing in the United States.” JAMA Viewpoint 318(7):1-2.

3 Centers for Disease Control and Prevention. Annual Surveillance Report of Drug-Related Risks and Outcomes — United States, 2017. Surveillance Special Report 1. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2017. Accessed 02/26/2018 from https://www.cdc.gov/ drugoverdose/pdf/pubs/2017 cdc-drug-surveillance-report.pdf.

4 Blumenthal, Susan, M.D., Kaplan, Emily. (2017, August 9). “The Opioid Epidemic Is A National Public Health Emergency.” Huffington Post. Retrieved from www.huffingtonpost.com.

5 Stempniak, Marty. (2016, March 2) “How Hospitals are Fighting on the Frontlines of the Opioid Crisis.” Hospitals and Health Networks. Retrieved from www.hhnmag.com.

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