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Dr. Bryan McLelland: The first step in combating the epidemic: limiting opioids in the doctor’s office

The opioid epidemic has crept into every corner of our country – from major cities to rural towns – and Washington state is no exception. In fact, in 2016 alone, enough opioids were prescribed in Washington for every resident to have 42 pills each.

Due to the impact the opioid epidemic is having on communities across the country, a growing number of local governments are taking action. Almost two years ago, Gov. Jay Inslee issued an executive order marshaling the state’s resources to combat the crisis. These efforts include preventing unnecessary opioid prescribing and treatment expansion for those dealing with addiction.

Research shows that more than 70 million patients receive opioids after surgery each year, and 1 in 10 patients reports becoming addicted to or dependent on these medications As a practicing oral and maxillofacial surgeon, I have seen how freely opioids are prescribed after common procedures, including wisdom teeth removal. It’s clear that doctors and surgeons must be more thoughtful in their approach to managing pain by balancing the need to address pain with the risk of overprescribing powerful opioids. This can be a struggle, and as a recent JAMA study revealed, more than two-thirds of patients have leftover opioids after surgery, resulting in a high number of pills available for possible diversion or misuse. Because of these factors, I began to search for alternatives to opioids.

In my practice, which has offices in both Spokane and Post Falls, I started using a long-acting, nonopioid option called Exparel. Exparel is injected during surgery and can provide patients with pain control for the first few days following surgery – when pain is often at its worst. Since implementing this approach, my patients are reporting lower pain scores – in fact, most patients are reporting a 1 out of 10 on the pain scale. Most importantly, I have been able to reduce the number of opioids I prescribe by nearly 75 percent. In my experience, this pain management protocol has shown a significant decrease in opioid exposure without compromising patient care or satisfaction.

Patients and surgeons are demanding these alternatives, paving the way for effective nonopioid options that don’t carry a risk of addiction or dependence. I believe it’s imperative that we actively educate our patients on the options available to manage pain after surgery. In my practice, the topic of nonopioid pain management is addressed during each patient’s initial consultation. Further, following a surgical procedure, my patients receive a card that outlines the benefits of using traditional over-the-counter medications such as ibuprofen and acetaminophen. By taking these steps, we empower patients to have control over their own pain management plan, all while reducing unnecessary exposure to opioids.

I’m hopeful that the steps we’re taking in Washington will have an impact. The medical community, along with patients across the state, can make a difference. The road to reducing our reliance on opioids is a long and challenging one; however, an open dialogue and smarter prescribing will pave the way for effective pain management with limited opioid use.

Dr. Bryan McLelland is an oral and maxillofacial surgeon with nearly 20 years of experience. He practices out of Liberty Oral & Facial Surgery, which has offices in Spokane and Post Falls.


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