Education is key

As many of you know, the Academy recently launched a new public service advertisement (PSA) campaign on the dangers of opioid misuse. This campaign includes display and radio ads urging doctors and patients to exercise caution in prescribing and taking opioids.

The campaign was distributed to hundreds of outdoor billboard/sign companies and radio stations across the United States. In San Diego, the display ads were featured at and near the AAOS Annual Meeting, generating more than 400,000 impressions from meeting attendees, residents, and visitors. As of April 1, the radio ads, created in partnership with the Orthopaedic Trauma Association, have aired on 93 stations more than 3,940 times.

The PSAs are part of the Academy's multifaceted strategy to educate orthopaedic surgeons and their patients about the dangers associated with opioids. The ads complement the Academy's other proactive prescription safety efforts, which include the following:

• A new Pain Relief Took Kit available to members at AAOS.org/Quality/PainReliefToolkit The online resource includes pre- and postoperative discussion talking points on pain relief, common pain relief solutions, orthopaedic and emergency department opioid strategies, a questionnaire for determining patient opioid addiction risk, and safe use storage and disposal strategies/resources.
• The revised AAOS information statement, "Opioid Use, Misuse, and Abuse in Orthopaedic Practice."
• Ongoing participation as one of 25 association/society members of the American Medical Association Task Force to Reduce Opioid Abuse.
• An OrthoInfo.org patient page at OrthoInfo.org/prescriptionsafety

Help us spread the word
As members, you can help share the Academy's prescription safety message by doing one or more of the following:

• Order free wall posters for your office by emailing media@aaos.org, or online in the "Store" at AAOS.org.
• Share the PSA statistics on professional and personal social media pages using #PrescriptionSafety.
• Share articles, facts, and statistics on opioid misuse on your practice web page or social media platforms.
• Visit the new Pain Relief Tool kit and utilize the new tools and resources in your daily practice.
• Promote your expertise by authoring a short prescription-safety related blog-post for A Nation In Motion®.
• Direct your patients to OrthoInfo.org for safe pain management strategies.

The United States is in the midst of an opioid epidemic, with millions of people dependent on or addicted to prescription painkillers such as codeine, morphine, oxymorphone, tramadol, hydrocodone, or oxycodone. As orthopaedic surgeons we are committed to helping our patients safely manage pain. Together, we can ensure that these efforts don't cause unnecessary addiction or harm.

Alan S. Hilibrand, MD, chairs the AAOS Communications Cabinet.

A Little Pain…A Lot of Gain
Elizabeth Matzkin, MD

Our nation's current opioid epidemic statistics are staggering and sad. They are also a wake-up call that orthopaedic surgeons need to change the way they manage pain and prescribe opioids. Consider the following:

• The United States consumes 80 percent of the global opioid supply and 99 percent of the world's hydrocodone.
• Viewing pain as a fifth vital sign, which began in the 1990s, and measuring patient satisfaction by minimizing pain have contributed to the current opioid epidemic.
• Opioid abuse has increased 3-fold in recent years.
• U.S. opioid deaths are more common than motor vehicle accidents and suicides.
• 80 opioid-related deaths occur each day.
• Orthopaedic surgeons are the third highest opioid prescribers.

As orthopaedic surgeons, caring for our patients requires that we provide them not only with the best treatments possible, but also alleviate their pain safely and effectively. In striking this delicate balance, we need to be aware of the risks and benefits of opioids.

Some patients never take opioids after surgery, while others seem to need more than usual. We all have had patients who admit to overtaking their opioids, sharing them, and/or selling them. This needs to stop. We need to communicate with our patients that some pain is to be expected following surgery. We need to work with them to control pain both ­reasonably and responsibly, and we both need to agree on expectations.

We should no longer prescribe opioids to our patients "just in case you need them." Simple procedures can be managed with local anesthetics injected at the end of the procedure, cryotherapy (ice), long-acting NSAIDs, and acetaminophen as needed. If procedures are expected to be more painful, then opioids can be prescribed accordingly (some states have legislated prescribing no more than a 5-day supply of opioids).

When counseling patients on pain and pain relief, keep in mind the following:

• Athletes work through pain. Our patients are our athletes.
• Athletes train to be better. They endure pain as they train toward their goals.
• Surgery is performed to make patients better. Patients endure the pain of rehabilitation to reach their individual goals.
• We have all heard, "no pain, no gain" or "the pain you feel today will be the strength you feel tomorrow."
• Pain provides information, is temporary, and serves a purpose. We need to focus on that purpose and not the pain.
• A little pain can lead to a lot of gain.

Elizabeth Matzkin, MD, is a recent member of the AAOS Communications Cabinet.