Pinehurst Surgical Clinic cuts down on narcotic prescriptions — 6 lessons learned

David Grantham, MD, launched a narcotics reduction program at Pinehurst (N.C.) Surgical Clinic to address widespread opioid use disorder in North Carolina, reports.

Six takeaways:

1. Nearly 1 in 20 people living in the state have an opioid use disorder. More than 13,000 North Carolinians have died from opioid overdoses in the past two decades.

2. Dr. Grantham thought his clinic could help address the problem. To get started, he asked each department to list procedures that would normally involve narcotics prescriptions. Then, providers were asked to agree on how many pills should be prescribed after those procedures.

3. Some departments significantly limited the use of narcotics, while others adopted a narcotic-free approach. The general surgery department reduced narcotics prescriptions by 35 percent in a year.

4. Pinehurst encourages patients to manage acute short-term pain through diversionary tactics, breathing and massage techniques, and non-narcotic medicines. Pinehurst providers also help patients expect and prepare for postoperative pain.

5. The clinic's providers determine the quantity of pills necessary based on patients' individual circumstances, according to Dr. Grantham. "I don't want there to be a perception that we are not giving medication if the patient needs it," he said.

6. State Sen. Tom McInnis, R-Richmond, an advocate for limited narcotic use, is aware of Pinehurst's pilot program, Dr. Grantham said. Mr. McInnis was a sponsor of the Strengthen Opioid Misuse Prevention Act, which requires physicians to consult the state's controlled substance database system and requires pharmacists to report controlled substance transactions within 24 hours.

"Physicians may have played a role in helping to start this epidemic, but we are now playing an active role in minimizing the potential for addiction. And we are limiting the number of pills out in the community," Dr. Grantham told "This is part of what we consider good medicine is to make a dedicated effort to decrease opioid use."

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