Dependence-free pain relief

In recent times, attention has centered on the use of opioid medications, including morphine and related analgesics like hydrocodone. While considered a blessing for patients experiencing severe and acute pain, the potential for addiction and the risk of fatal overdose also pose a significant challenge.

The opioid crisis, claiming thousands of lives annually in the United States and Canada due to overdoses, is now casting a shadow over Europe. Over the past decade, there has been a significant increase in the prescription of opioids, particularly hydrocodone.

Research collaboration between Baden State Hospital’s pharmacy and the Swiss Federal Institute of Technology (ETH) has played a crucial role in addressing this issue, with the project running for over four years. Led by Professor Andrea Burden, an epidemiologist specializing in pharmaceuticals, and her colleague Dominik Stämpfli, a clinical pharmacist in the Baden State Council and a scientist in ETH’s Burden research group, the project aims to optimize treatment strategies.

The Best Treatment Approach

The researchers focus on various aspects, including the risks posed by medications to patients and how to enhance drug management to ensure maximum benefit for patients undergoing treatment. Their goal is to minimize the frequency of side effects, the risk of overdose, and the development of drug dependence.

Readmission is also part of their research. One crucial goal of care is to avoid post-discharge complications that may necessitate readmission. Opioids become a key factor here, and ETH’s master’s students, under the supervision of Stämpfli and Burden, conduct data analysis.

The analysis reveals an increased risk of readmission within 30 days for patients still taking opioid analgesics upon discharge. “The results confirm what we already knew: we need to better care for patients receiving opioid medications,” Stämpfli states.

According to health insurance data analysis in Switzerland, excluding patients treated for cancer pain with opioids and those under controlled doses supervised by medical professionals, approximately one-third of physicians prescribing opioids continue the medication for over 12 months. However, evidence suggests that while opioids can be used for acute and palliative pain treatment, they should not be used long-term for chronic pain.

This is because prolonged use may increase sensitivity to pain, hinder recovery, or lead to opioid use disorders with the risk of overdose. Therefore, recommendations on how to appropriately utilize these medications in hospitals are crucial. At Kantonsspital Baden, a team is collaborating with inpatient clinical physicians, nurses, and primary care practitioners to develop proper guidelines. This will also include recommendations on how physicians and nurses can collaborate to ensure patients ultimately cease opioid use.

Discharge without Opioids

“Patients need better support for opioid medication treatment; we should not leave them to deal with this issue alone,” Burden emphasizes. This support may involve closer monitoring of patients during their hospital stay and initiating a gradual dose reduction early. “Ideally, this tapering process should be completed before the patient is discharged so they can leave without opioids,” Stämpfli suggests.

Meanwhile, patients who still require opioid analgesics after discharge should receive detailed information on correct usage, either through discussions with clinical physicians or in the form of pamphlets. Patients and their primary care physicians need to know at what rate they should gradually reduce opioid medication for acute pain. Therefore, Baden State is collaborating with Burden on a study evaluating the effectiveness of different tapering strategies.

“This is not about denying patients access to opioid medications, as they have the right to alleviate excessive pain,” Burden says. “It’s more about responsibly using these analgesics, essentially meaning using them for short-term relief of acute, severe pain and coupling it with a clear exit strategy.”

The collaboration between the Baden State Council and ETH has proven beneficial for both parties. “ETH doesn’t have a medical school; by collaborating with hospitals, we have the opportunity to conduct research and clinical studies using patient data,” Burden explains.

For her, the primary benefit comes from close interaction with physicians, nurses, and pharmacists who deal with urgent issues daily. “Scientists like us bring research expertise to help them find the answers they need,” she concludes.

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