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Enhanced Recovery Programs And the Opioid Crisis

Enhanced Recovery Programs And the Opioid Crisis. Katharine L. McGinigle, MD MPH Director, UNC Enhanced Recovery Program Assistant Professor, Department of Surgery University of North Carolina June 11, 2019. No disclosures. Panel Members. Dr. Adam Beck – University of Alabama

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Enhanced Recovery Programs And the Opioid Crisis

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  1. Enhanced Recovery Programs And the Opioid Crisis Katharine L. McGinigle, MD MPH Director, UNC Enhanced Recovery Program Assistant Professor, Department of Surgery University of North Carolina June 11, 2019

  2. No disclosures

  3. Panel Members • Dr. Adam Beck – University of Alabama • Dr. Samantha Minc – West Virginia University • Ms. Megan Collins – Valley Health

  4. Drug overdose is #1 cause of death for Americans under 50 years old 70,237 people died due to overdose in 2017 Greater than annual deaths related to gun violence, HIV, or motor vehicle collisions https://www.cdc.gov/drugoverdose/data/statedeaths.html

  5. Jones CM. Drug and Alcohol Dependence. 2013

  6. 44-88% of opioid misusers identify their own prescriptions or those of friends and family as a common source Daniulaityte R. et al. Journal of Psychoactive Drugs, 2014

  7. New chronic use of opioids after surgery is 6% • Does not differ between major and minor surgeries • Independent risk factors: tobacco use, alcohol and substance use disorders, mood disorders, and preoperative pain disorders Brummett et al. JAMA Surg. 2017

  8. Each additional refill increased the rate of misuse by 70.7% • Each additional week of opioid use increased the rate of misuse by 34.2% Brat et al. BMJ 2018

  9. UNC’s Opioid Stewardship Program

  10. Enhanced Recovery After Surgery • 5 principles: • “Patient as a partner in their own care” • Right decision • Prepared – best possible pre-op state, resilience • Cared for – least possible harm • Recovered – back to or better than before Kehlet, H. Multimodal approach to control postoperative pathophysiology and rehabilitation. British Journal of Anesthesia 1997; 78: 606-617.

  11. Enhanced Recovery After Surgery Figure 1. A typical ERAS flowchart detailing different protocol items implemented over the course of care (1).

  12. ERAS reduces opioid Rx *GynOncpatients Data from Dr. Kevin Elias

  13. Panel Discussion

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