Dr. Scott Sigman, MD, the original opioid-sparing orthopedic surgeon, shares his thoughts on the opioid epidemic, and orthopedic strategies to reduce the use of opioids, in a series of podcasts recently:
In a slightly “safer for work” version, read on for Dr. Sigman’s thoughts on the opioid crisis, its impact on orthopedic surgeons, and how he’s approached changes to his practice.
Opioid overdose now causes more deaths in the United States than car accidents each year. The growth in opioid abuse is particularly pronounced in New England. Dr. Sigman shares:
“How did we get here? Why is this happening? Why is it that an 18-year-old kid gets a scholarship to play hockey, tears his ACL, and 6 months later is dead?”
In light of recent studies, orthopedic surgeons are right to question traditional protocols. One study of opioid prescriptions for acute pain demonstrated an exponential uptick in abuse with opioid prescriptions greater than 7 days. As the median post-surgery prescription in some states studied was 30 pills, and the median consumption was 9 pills, physicians must manage not only risk to the patient but also the risk of pill diversion.
Dr. Scott Sigman is now ‘anti-opioid’. When he started practicing 25 years ago, doctors were told in medical school, “We are going to use these opioids because they’re inexpensive and non-addictive. Absolutely not true. Did big pharma influence this? Sure. The culture around pain in the early 90s was about the process of making sure your patients were out of pain.” Dr. Sigman advocates for changing the thinking around pain management, and exploring alternative techniques and technologies.
“I’ve been on a 5-year pilgrimage, and we are really gaining traction.”
Dr. Sigman advocates for:
- Talking about family history of addiction
- Minimizing exposure to opioids in the first place, so that 6% of those likely to be highly addictive are never exposed
- Limiting post-surgery prescriptions to seven days or less
- Exploring techniques like nerve blocks for a “soft landing”
- Looking to laser therapy for pain management
“I love the challenge, love the excitement…we are healing people. You can avoid surgery. We’re also using it after surgery. And for acute disease….you see these NFL players with an ankle injury and they’re back playing in a week” Dr. Sigman has seen such success with MLS laser therapy, that he has opened an orthopedic laser center in Chelmsford, MA, where he currently treats 70 patients a day.