Questions: What are the most common challenges faced by your specialty when working with surgical patients with OUD? (n = 228) What are the barriers for using medication (such as buprenorphine, methadone, naltrexone) for OUD in the hospital? (n = 217) | ||
Theme | Subtheme | Quote |
Lack of Knowledge (65%) | Surgeons are not trained nor educated to prescribe MAT | Need training on additional pain medication to treat acute postoperative pain on top of chronic dose. Poor understanding of how to prescribe (dosing) and/or manage these medications or their side effects combined with a lack of physicians to then follow those patients. |
Lack of experience | I don’t have experience managing substance abuse for patients who need acute pain control. The patient’s pain specialist is reluctant to prescribe medications acutely after surgery, despite doses in excess of my comfort level and training. | |
Fear of contributing further to patient’s addiction | It is difficult balancing the control of postoperative pain with pain seeking behavior (diversion). | |
Communication and patient expectation setting | Most patients have low postoperative pain scores but use opioids for sleep, feeling relaxed, and manage pain at other non-operative sites. Patients don’t see the harm in taking the medication provided to them, approaching it in a naïve way. | |
Lack of Resources (29%) | Lack of access to (pain/addiction) specialists/lack of care coordination | Sometimes it’s hard getting in touch with the methadone clinic to work out missed doses and formulate a plan of care. Buprenorphine has largely been regulated to pain management and palliative care but pain management does not prescribe for outpatients. |
Lack of infrastructure (EHR); restrictive regulations by state/insurance | (Institutional hurdles) Existing standard order sets include easily ordered high opioid dosing. Hard to decrease dosing or not order for those patients stating no opioids. If surgeon order high opioid doses, they could be subject to discipline. On the other hand, they could be cited for poor patient pain control. | |
Lack of transition of care following postoperative pain control to maintenance therapy and dosing | There is a lack of coordination of care with their pain management/addiction physician. Insurance doesn’t cover the cost always of non-opioid alternatives. Unfortunately, it’s easier to prescribe an opioid. |