NYGH reduces opioid prescriptions to help curb misuse

Thousands of people in Ontario likely have unused opioid painkillers sitting in their medicine cabinet or bedside drawer, long after they have a need for them. These medications, which are not usually stored securely, may be indirectly contributing to the widespread opioid crisis.
According to the Centre for Addiction and Mental Health, “More than two-thirds of students (67%) using opioid painkillers non-medically reported getting the medication from home.” This statistic caught Dr. Sanjho Srikandarajah's attention while he was attending a conference. As an Anesthesiologist at North York General Hospital (NYGH), he wanted to know if hospitals were inadvertently playing a role in this dangerous cycle and if anything could be done to reduce opioids from being misused by youth and adults.
Members of the NYGH anaesthesia and surgical team worked in partnership with the an hospital’s pharmacy department to reduce the number of opioids prescribed to day surgery patients, as well as develop new patient education materials.
Members of the NYGH Anesthesia and Surgery team worked in partnership with the hospital’s Pharmacy Department to reduce the number of opioids prescribed to day surgery patients, as well as develop new patient education materials. From left: Anesthesiologist Dr. Aaron Mocon, Anesthesiologist Dr. Brian Yau, Anesthesiologist Dr. Sanjho Srikandarajah, Pharmacist Jenny Chiu, Anesthesiologist Dr. Brian Kashin, and Surgeon Dr. David Smith.
Dr. Srikandarajah and Dr. Adina Feinberg, a Surgical Resident, conducted a systematic review of the literature to look at prescribing patterns of opioids post-surgery.They found there was very little written about how much pain medication patients should be prescribed after surgery or how much patients were actually using once they left the hospital.

Dr. Adina Feinberg, Surgical Resident“Since there are no hard and fast rules for prescribing opioids after surgery, surgeons typically provide patients with a prescription that ensures they will not run out of painkillers once they are recovering at home,” says Dr. Feinberg. “We know that well-controlled pain is necessary in order for patients to recover properly, but without evidence-based guidelines, it's sometimes hard to know the optimal amount to prescribe.”

Surgical Resident Dr. Adina Feinberg

Number of opioids prescribed to day surgery patients reduced by almost 50%

The systematic review was taken another step further to examine the prescribing practices at NYGH with a research grant from NYGH's Exploration Fund, a granting competition designed to provide initial funding for staff and physicians to develop new ideas for the delivery of care. After looking at three months' worth of prescriptions that were written for appendix and gallbladder day surgeries, Drs. Srikandarajah and Feinberg determined that patients were being prescribed about 20–30 tablets, but only used 3–4 of them.

“We realized that thousands of unused pills had been prescribed within these three months alone and that many of these opioids were probably still circulating in the community — potentially contributing to accidental harm or misuse,” says Dr. Srikandarajah. “With this new information we have been able to implement changes to reduce the number of opioids prescribed to day surgery patients by almost 50%.”

NYGH now has a new standardized electronic prescription, which provides just 10 tablets of opioid medication, without impacting patient satisfaction scores with their pain levels. As a result of this initiative's success, Dr. Srikandarajah is working with other Ontario hospitals to help inform their prescribing practices with this new evidence.

This research also revealed that a majority of patients do not know how to safely store or properly dispose of their unused pills, contributing to medication getting into the wrong hands.
Educating patients and families on better opioid use, storage and disposal

NYGH Pharmacist Jenny Chiu collaborated with anesthesiologists, surgeons and nurses to determine how to better educate patients and families on opioid use, storage and disposal in order to support the safe use of pain medication.
More than two-thirds of students (67%) using opioid painkillers non-medically reported getting the medication from home.
A new brochure has been developed in partnership with the Institute for Safe Medication Practices Canada and is being given to patients before they leave the hospital.
Handout: Prevent Medication Accidents
Read the handout on using opioids after day surgery and preventing medication accidents. Download: Handout on opioid use, storage and disposal.

Listen to Dr. Sanjho Srikandarajah discuss the overprescription of opiods in a March 15, 2018, interview on CBC's Metro Morning.

May 2, 2018

NYGH's strategy: This initiative supports NYGH's strategic pillar to TRANSFORM Care through Applied Research and Innovation. Learn more about our strategy.

This article first appeared in the May 2018 issue of The Pulse, North York General Hospital's community newsletter. Subscribe to receive 10 issues per year.

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