We know that legitimately prescribed painkillers are often the first step for people who become addicted to opioids through no fault of their own.
So what happens when you’re a former opioid addict who successfully went through the hard work of getting sober, and then you dislocate your shoulder? Life happens, after all.
Jacob Metzler is a former opioid addict in his late 20s. Described as “hardworking,” his doctor, Scott Sigman, said Metzler’s shoulder pain became so unbearable for him after a dislocation that he was unable to work.
But to have surgery and take post-operative narcotics seemed out of the question to Metzler. “Jacob looked around and eventually found me, having heard through the grapevine that doctors are using medication that can allow surgery without any narcotics,” said Sigman.
Sigman is a board-certified orthopedic surgeon in Lowell, Mass., one of the nation’s many epicenters for opioid addiction (although, as Sigman pointed out, there is not a single community in America untouched by this epidemic). Sigman is the team physician for the U.S. Ski Jump Team and all men’s and women’s sports teams at the University of Massachusetts.
Sigman also is a consultant to Pacira Pharmaceuticals and has contributed to numerous publications and research studies regarding advances in the field of orthopedic surgery.
In an interview with OpiateRehabTreatment.net, he described how he used a new drug called Exparel to get Metzler through shoulder relocation surgery without a relapse into his addiction.
Technique Offers a Soft Landing from the ‘Pain Storm’
Exparel can be injected into bone or soft tissue at the surgical site and was approved by the FDA more than two years ago. It essentially is a numbing agent, much like Novocain used by a dentist. The difference is that Exparel can stave off pain for up to three days.
In the case of Metzler, no opioids were needed. “There was a complete rehabilitation,” Sigman said. “It was like a country song going backwards. He got his job back, picked up even more work and now he has a girlfriend.”
As a doctor who works with athletes of all ages, Sigman said it’s important that young athletes and their parents know about Exparel too. High school children given opioids after sports injuries surgeries may be at additional risk for developing opioid addiction.
Each year, more than 70 million patients received opioids after surgery, Sigman said. One in 15 will go on to long-term use of the medications, putting them at risk for addiction. “We have no data points identifying who that is going to be. I use this medication on every single patient that I can.”
While Exparel is FDA-approved for adults 18 and older, he considers “all hands on deck” when considering its use. “If I have a patient that is 16, I will have a conversation with the parent, and discuss using it off label, explain how it is specifically approved by the FDA, but that the child is more or less physiologically an adult,” Sigman said. “Clinically, I have seen 17-year-old athletes with college scholarships sustain a knee injury and be given 40 pain pills. And then they go on to become one of those one out of 15.”
Dangerous Mix: Heavy Drinkers Require More Narcotics for Relief
In a story published in Orthopedics Today, Dr. Thomas Higgins said, “If you look at where prescriptions are coming from, orthopedic surgeons are third in line in terms of who is providing these after family doctors and internal medicine doctors. But there are far more family practice and internal medicine doctors, so I think we are overrepresented in terms of prescribing, and it is a national epidemic in terms of mortality.” 1
The story warned that some people require more narcotics than others, and warned of the dangers of addiction.
“People who drink a lot will actually not respond to narcotics, so drinkers require higher doses of narcotics to keep the patient comfortable after surgery,” Dr. Carlos Lavernia of the Orthopaedic Institute at Mercy Hospital told Orthopedics today.
Sigman said that even among those who don’t have a risk for becoming addicted to opioids following orthopedic surgery, the painkiller “leftovers go into the medicine cabinets, and then out onto the streets. Kids know where to go to find to them. Then we have another one out of 15 (leading to long-term use).”
People requiring surgeries who come from families where drug and alcohol addiction is common also should avoid putting themselves at risk for developing opioid dependence, Sigman said. “Patients have a choice. We’re educating our doctors, and now we need to educate our patients. There are alternatives (to opioids). Patients should be asking questions and directing their own care.”
1.Orthopedics Today. (2012, January). With concerns over narcotics, some surgeons develop alternative pain management protocols. Retrieved May 25, 2016, from http://www.healio.com/orthopedics/business-of-orthopedics/news/print/orthopedics-today/%7B8734409d-638f-42f4-b1b7-c3726a579470%7D/with-concerns-over-narcotics-some-surgeons-develop-alternative-pain-management-protocols
Written by David Heitz