For children, the opioid epidemic can be about adults in their lives with opioid use disorder or accidental overdoses when a child finds their parent's pill bottle. But kids can also get addicted to opioids.

Mayo Clinic's Courtney Baker, M.D., an orthopedic surgical resident, and his mentor, Todd Milbrandt, M.D., a pediatric orthopedic surgeon, decided to lessen the chances of these happenings. Together with other colleagues from Orthopedic Surgery and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, they led the implementation and evaluation of tiered prescribing guidelines for discharge opioid prescriptions following common pediatric orthopedic procedures.

In a recent article in the Journal of Pediatric Orthopedics, the team describes their findings.

"The first shocking thing we found was a 60% reduction in opioids prescribed based on this simple intervention," says Dr. Baker, the study's first author. "This means a drastic reduction in the amount of extra opioids available in the home."

"Second, adherence to the guidelines was over 90% by providers," he continues, "which means that these guidelines were easily adopted and maintained with minimum education or training required."

The team worked with Mayo's pediatric orthopedic surgeons to develop a tiered list of 28 procedures — according to the invasiveness of the procedure and a typical postprocedural opioid requirement. They then developed a tiered dosing table for oxycodone, and another for hydrocodone/acetaminophen, based on the weight of the patient and the level of the procedure. These guidelines were distributed across Mayo's Practice in January 2018 and implemented during that year.

All patients, ages 0-17 who underwent one of the 28 procedures in 2017 — prior to guideline development — were compared to all similar patients from 2019.

Read the rest of the article on Advancing the Science.

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Naloxone is a potentially lifesaving medication that can temporarily reverse the effects of an opioid medicine. It can be easily administered to those who overdose. Many who are battling the opioid epidemic would like to see naloxone made more readily available.

Dr. Halena Gazelka, host of the Mayo Clinic Q&A podcast, is also chair of Mayo Clinic's Opioid Stewardship Program Subcommittee. She is a strong advocate for breaking the stigma of opioid use disorder.

In this Mayo Clinic Q&A podcast, Dr. Gazelka talks with Dr. Bonnie Milas, an anesthesiologist and critical care physician from the University of Pennsylvania. They discuss naloxone, the opioid epidemic and the tragic loss of Dr. Milas' two sons to opioid overdoses.

Watch: Drs. Gazelka and Milas discuss the opioid epidemic and the need to use naloxone.

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ROCHESTER, Minn. ― The opioid epidemic in the U.S. is becoming a bigger problem medically, socially and financially, and the COVID-19 pandemic has made it worse, according to the Food and Drug Administration.

Heart surgeons have seen a disturbing trend over the past decade: more and younger patients with infective endocarditis requiring heart surgery. Infective endocarditis is an infection caused by bacteria that get into the bloodstream and settle in the heart lining or a heart valve.  IV drug use can introduce aggressive bacteria that can quickly and severely injure heart valves.

Juan Crestanello, M.D., a Mayo Clinic cardiovascular surgeon, has insights into this trend. Dr. Crestanello is senior author on a multicenter study that looked at nearly 35,000 valve operations for infective endocarditis from 2011 to 2018.

Study highlights include:

• More than one-third of heart valve operations were for infective endocarditis related to drug use.
• There was a more than twofold increase in valve operation in this category of patients.
• There were regional differences, with the greatest increases found in the East South Central and South Atlantic regions, and New England.
• Patients with infective endocarditis related to drug use were typically younger, with a median age of 36. They also had a higher rate of smoking, drinking and liver disease. And they were more likely to need emergency surgery, and be on Medicaid or uninsured.

Media: To interview Dr. Crestanello, contact Terri Malloy at newsbureau@mayo.edu.

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Opioid pain medication can hook people into addiction quickly. Some worry that EDs are a major source for these drugs.

Dr. Jeffery says, “One thing that sort of everybody thinks they know about opioids is that, in the ED, they give opioids out like candy.”

Not true, says Dr. Jeffery. She and her colleagues published a study that found opioid prescriptions from the ED are written for a shorter duration and smaller dose than those written elsewhere. They also found that patients with acute pain who receive an opioid prescription in the ED are less likely to progress to long-term use.

“What we want to avoid is people having a large prescription and having lots of pills leftover because, at that point, it becomes a risk for their family members and other people who come to their home.”

Centers for Disease Control and Prevention guidelines caution against exceeding a three-day supply or 50 milligrams of morphine equivalent per day for acute pain.

“And, so, limiting prescriptions to three to seven days is a good balance.”

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Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:00) is in the downloads. Read the script.

What exactly is the opioid epidemic? Is it about prescription drugs or heroin?

“It’s a combination of both problems.”

Dr. Hooten says back in the mid- to late 1990s …

“... opioids were being recommended to treat chronic pain. The problems associated with long-term opioid use include, probably the most important is, addiction to the medication.”

Today, the term for opioid addiction is “opioid use disorder.”

“Symptoms of opioid use disorder include, primarily, an increasing preoccupation with the medications. So individuals will start organizing their lives and organizing their daily structure around taking that particular medication.”

And for some struggling with severe addiction, if they can’t get medication from their health care providers, they may turn to heroin. But you can break an opioid addiction.

“There are other nonopioid medications that can be helpful. There are other behavioral interventions that can help individuals learn to manage and cope with pain.”

The post Mayo Clinic Minute: Facts on the opioid epidemic appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Michael Hooten, an anesthesiologist and pain medicine specialist at Mayo Clinic, will discuss the opioid epidemic in America. Also on the program, Dr. Steve Peters, chief medical information officer, Mayo Clinic, will explain the Plummer Project — Mayo Clinic's institutional move to a single, integrated electronic health record and billing system. And Dr. Douglas Wood, medical director, Mayo Clinic Center for Innovation, will preview the upcoming Transform 2017 conference.

To hear the program, find an affiliate in your area.

Here is this week's Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

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Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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In this Mayo Clinic Minute, reporter Vivien Williams discusses when it's OK to take opioid pain relievers with pain management specialist Dr. Mike Hooten.

Watch: The Mayo Clinic Minute

Journalists: The broadcast-quality video pkg (0:58) is in the downloads. Read the script.

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In this Mayo Clinic Minute, reporter Vivien Williams talk to pain medicine specialist Dr. Mike Hooten about when it is appropriate to use opioid pain medication.

View complete series:

• Mayo Clinic Minute: Prescription drugs ─ the changing face of addiction
• Mayo Clinic Minute: Facts on fentanyl
• Mayo Clinic Minute: Avoid opioids for chronic pain
• Mayo Clinic Minute: 2 reasons not to share pain pills
• Mayo Clinic Minute: When are opioids OK to take?
• Mayo Clinic Minute: What opioids do to your guts
• Mayo Clinic Minute: How to stop popping painkillers

Watch: The Mayo Clinic Minute

Journalists: The broadcast-quality video pkg (:58) is in the downloads. Read the script.

The post Mayo Clinic Minute: When are opioids OK to take? appeared first on Mayo Clinic News Network.

Many people who suffer with chronic pain find relief from opioid pain medication. Mayo Clinic experts say opioids may benefit a certain percentage of people with chronic pain, such as advanced cancer patients, but they are usually not the best long-term option for most.

In this Mayo Clinic Minute, reporter Vivien Williams discusses the pros and cons of opioid use for chronic pain with pain medicine specialist Dr. Mike Hooten.

View complete series:

• Mayo Clinic Minute: Prescription drugs ─ the changing face of addiction
• Mayo Clinic Minute: Facts on fentanyl
• Mayo Clinic Minute: Avoid opioids for chronic pain
• Mayo Clinic Minute: 2 reasons not to share pain pills
• Mayo Clinic Minute: When are opioids OK to take?
• Mayo Clinic Minute: What opioids do to your guts
• Mayo Clinic Minute: How to stop popping painkillers

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

The post Mayo Clinic Minute: Avoid opioids for chronic pain appeared first on Mayo Clinic News Network.

In this Mayo Clinic Minute, reporter Vivien Williams talks to pain medicine specialist Dr. Mike Hooten about fentanyl.

View complete series:

• Mayo Clinic Minute: Prescription drugs ─ the changing face of addiction
• Mayo Clinic Minute: Facts on fentanyl
• Mayo Clinic Minute: Avoid opioids for chronic pain
• Mayo Clinic Minute: 2 reasons not to share pain pills
• Mayo Clinic Minute: When are opioids OK to take?
• Mayo Clinic Minute: What opioids do to your guts
• Mayo Clinic Minute: How to stop popping painkillers

Watch: The Mayo Clinic Minute

Journalists: This broadcast-quality video pkg (1:00) is in the downloads. Read the script.

The post Mayo Clinic Minute: Facts on fentanyl appeared first on Mayo Clinic News Network.