Opting Out of the Federal Rule Requiring Physician Supervision Does Not Increase Access to Anesthesia Care, Study Finds

The Medicare “opt-out” rule that allows anesthesia to be administered without physician supervision does not increase patient access to anesthesia care, according to a study recently published online in Anesthesia and Analgesia. The study shows that overall, opt-out states experienced a lower growth in anesthesia cases (anesthesia utilization rates) compared with non-opt-out states, suggesting that opt- out is not associated with an increase in access to anesthesia care.

Read the full article in the NSA March Newsletter (pdf download).

Five Tips for Pain Management with Opioids: What You Need to Know About Common Prescription Medications

Millions of Americans take prescription pain medications called opioids. While opioids control pain, they’re not without risk: each day 44 people die from opioid overdoses and 80 percent of those deaths are unintentional.

Prescription opioid abuse and misuse have become epidemic, with more than 2 million Americans addicted to the pain relievers. However, opioids can play an important role in controlling moderate to severe pain (whether it is from surgery, injury, cancer or has become chronic) as long as patients take their medications appropriately and are under the close care of a physician anesthesiologist or other pain medicine specialist. Because opioids can produce euphoria, they are highly addictive and can “rewire” the brain into believing the drug is as necessary for survival as food. Eventually the patient tolerates the opioid dose and needs more to relieve the pain or achieve well-being, which can lead to dependency.

“About 100 million people suffer with chronic pain and many of them rely on opioids,” said Daniel J. Cole, M.D. president of the American Society of Anesthesiologists (ASA).

When managed safely and carefully, opioids can be effective, but patients need to be careful with these medications. It’s vital that they talk to their pain medicine specialists about using them safely and also exploring alternative options.

During Patient Safety Awareness Week (March 13-19), ASA developed five tips for patients regarding opioids for pain control:

  • Talk with your physician: If your physician prescribes an opioid (common ones include fentanyl, oxycodone and hydrocodone), be sure to have a detailed conversation about how to minimize the risks. Your doctor will ask if you have taken opioids before (and if so, how they affected you) or have a history of addiction as well as assess whether any conditions you have could increase the risk of side effects. Possible side effects range from mild (such as sleepiness or constipation) to more serious and life-threatening effects, such as shallow breathing, slowed heart rate and loss of consciousness, which can be signs of overdose. Ask your physician what signs to look for and how to minimize potential problems. The ASA has information about the signs of opioid overdose and what to do about it – learn more at www.asahq.org/OpioidODFacts.
  • Take as directed: Because opioids are easy to misuse, be sure to carefully follow directions for taking them. Ask your physician about interactions with other medications you are taking or with alcohol.
  • Plan ahead for surgery:
    Before surgery – If you are already taking opioids for chronic pain and are having surgery, be sure to talk to your surgeon, physician anesthesiologist and other physicians to determine how to manage pain before, during and after surgery. It’s important to understand that chronic opioid use increases the risk of complications from surgery and may add to the length of your hospital stay.
    After surgery – Even if you do not usually take opioids, you may be prescribed an opioid to cope with pain after surgery. If so, take the medication only as long as necessary for pain control – two weeks at most. If you find you are still in pain a few weeks after surgery, tell your pain medicine specialist so you can explore other options for pain control.
  • Ask about combination therapy: Only about half the people taking opioids say they feel they have control of their pain. A newer method of pain control, multi-modal therapy, uses a combination of medications or other methods. This may not only help improve your pain management, but decrease the opioid dose you need to control your pain.
  • Consider non-drug therapies: Biofeedback (in which patients learn to control involuntary functions, such as heart rate), meditation, massage, acupuncture, surgical procedures and interventional therapies (such as nerve blocks) can help with chronic pain. Talk to a pain medicine specialist to learn what options might work best for you.

Before taking opioids, have a conversation with your physicians to understand how the medication will affect your body and how to use them safely. Learn more about how a physician anesthesiologist who specializes in pain management can help you control pain.