HealthLinks March/April 2018

54 | | A local group of oral surgeons has teamed up with health insurance giant Aetna in a pilot program designed to reduce opioid prescriptions with the use of a new, non-narcotic drug called Exparel. Opioid addiction “is becoming a major concern for parents,” stated Dr. Aaron Sarathy of Charleston Oral and Facial Surgery, whose practice was selected for the pilot study. Among 10-year-old to 19-year-old patients, dentists are the main prescribers of opioids. As an oral surgeon, Dr. Sara- thy routinely faces the decision to prescribe opioids for patients having a wisdom tooth removed. With Aetna now covering the cost of Exparel, Dr. Sarathy is beginning to see more patients opting for it as an alternative to an opioid prescription. “Ibuprofen is the workhorse of pain management,” stated Dr. Sarathy, one of four surgeons at COAFS. “The primary need for opioids occurs 12 to 24 hours post-surgery, just to take the edge off.” Administering a dose of Exparel during the procedure may reduce and possibly eliminate the need for opioids. A long-lasting analgesic, Exparel may well be an answer to the opioid crisis, providing non-narcotic relief for short-term post-op pain. Julie Lawrence, PharmD, BCPS, a volunteer for Wake Up Carolina, agreed: “We’re coming full-circle. We’re reverting to old-school, regularly scheduling doses of ibuprofen and acetaminophen. We’re finally starting to revamp pain protocols and dial back on opioids while still keeping people comfortable.” Legislation is in committee to establish continuing education requirements for prescribers. When she broke her ankle, Mary McGregor told her highly recommended orthopedic surgeon, “I am in recovery. Please do not prescribe any narcotics for me.” She elaborated, “Pills were never my problem, but I have the mind of an addict. I become mentally obsessed. My sobri- ety is my most prized possession, and I’m not taking anything which might put that in jeopardy.” Upon discharge, unbeknownst to her, the doctor slipped her husband a prescription for 60 OxyContin, “just in case she needs them over the weekend.” McGregor doesn’t believe her surgeon had bad intentions. “He was just not educated. He didn’t understand. Sixty pills is easily a new addiction. If he was concerned I would call him over the weekend, he should have prescribed a two-day supply.” Other bills are being considered – some extremely simple and just basic common sense: Develop and mandate the use of counterfeit-proof prescription pads, for example. In addition relying on the state to legislate changes, a power- ful grass-roots movement, born of a local tragedy, is beginning to bring the problem to light. “Mom, we can’t let another family go through this,” cried Nanci Steadman Shipman’s daughter, as her stunned, heartbro- ken family surrounded the deathbed of her brother, a young man you’d never dream would succumb to the disease of addiction. Wake Up Carolina, the resulting nonprofit, seeks to smash the stigma of addiction. “No one is immune to this disease,” stated Shipman, whose son Creighton ultimately became addicted as a result of being treated for a sports injury, a story remarkably resembling Miles’ – actually, not remarkable. Administering a dose of Exparel during the proce- dure may reduce and possibly eliminate the need for opioids.