Dartmouth-Hitchcock instituting new opiate guidelines

BURLINGTON, Vt. (WCAX) Doctors at Dartmouth Hitchcock Medical Center say they're developing better methods to prescribe opioids. They say it really comes down to paying attention to how many pills surgery patients take before they leave the hospital.

"We have a mandate to take care of our patients' pain, but we also have a societal responsibility to right size the amount of opioids we prescribe," said Dr. Richard Barth, Chief of Surgery at Dartmouth-Hitchcock Medical Center.

For Dr. Barth, curbing the amount of extra pills going home with patients means trying to set some guidelines for his surgeons. He says some New England states limit doctors to prescribing a seven-day supply of opioids, but some don't give guidelines on what number of pills that is. His latest research tries to fix that. "We wanted to quantify that and make it patient-specific," he said.

The guidelines are simple -- If a patient didn't take opioids the day before they left the hospital, they don't need any after discharge. If they took one to three pills, they should get 15. And if they took four or more on their last day, they should get 30.

Dr. Barth says those guidelines worked for 85-percent of the 333 abdominal surgery patients they studied. "The operation that we did didn't matter. So this guideline held for all six of those operations," he said.

He hopes other hospitals will now take his research and incorporate it into their prescribing. "This guideline holds for general surgical patients at Dartmouth Hitchcock. I see no reason why these guidelines can't hold for general surgical patients anywhere else in the country," Barth said.

So would other hospitals adopt those guidelines? "Guidelines are very helpful. They're a great place to start. I'm always a little worried about an exact number," said Dr. Stephen Leffler at UVM Medical Center. He says solid research like Dartmouth-Hitchcock's adds to the growing body of knowledge about safe prescribing, but he cautions against attaching specific numbers. "Everyone is different. Everyone handles their pain differently, and we live in a very rural place where it's not always easy for everyone to get a pharmacy and get their pain meds."

Dr. Leffler says he thinks Vermont's new prescribing law, which assigns a specific dosage based on how severe the pain is, gives their doctors a clear starting point to have conversations with patients about their pain management. "A lot of patients are at -- 'what can I do besides opiates' -- and that's a great conversation," he said.