After doctors performed a hysterectomy and removed Kammie Schutz’s ovaries due to endometrial cancer, she went home with only Tylenol and ibuprofen for pain relief. No opioids — and pain was not a problem.
“I was okay with it,” said the 46-year-old Wayland, N.Y., resident. “I never needed more than that. And everyone I’ve talked to who’s had similar surgeries tells me that narcotics are not the way to go.”
Schutz, who was treated by UR Medicine’s Gynecologic Oncology group, is part of a growing wave of patients at the Wilmot Cancer Institute and University of Rochester Medical Center who are recovering better and faster without opioids. She was diagnosed in September with stage 1 cancer, had surgery in October, and is feeling well.
“I highly recommend that if people can do it with just Tylenol and ibuprofen, then do it,” she said. “We need to stop the opioid epidemic.”
Doctors and nurses play a key role in stemming the opioids crisis. Authorities say that bypassing opioids, if possible, may be particularly important due to isolation during the coronavirus pandemic and less access to drug treatment, which may lead to rising rates of drug abuse and overdose deaths. And yet it is also essential that physicians and nurses help patients to manage pain and prevent suffering. Many providers at URMC are finding ways to do that without narcotics.
Karen Kugel, R.N., a URMC oncology nurse for 30 years who treated Kammie Schultz, recently released a small study, reported by the Oncology Nursing Society. It showed that it is possible to control pain after gynecologic surgery with non-opioid medications. Of the 35 patients Kugel’s team surveyed, 74 percent said they achieved effective pain relief with a non-opioid regimen. Seven patients needed only Tylenol. A dozen were prescribed opioids when they were discharged after surgery, but none of the patients needed to take them, the data show.
“We went from being a total opioid-prescribing practice to a non-opioid practice, and the reception from patients has been extremely positive,” Kugel said. “A day or two after surgery, they say they feel great. Some patients were quite surprised to see how quickly they could return to their regular routines.”
Likewise, the UR Medicine Department of Surgery is studying broad prescribing patterns for patients after all types of surgery, including cancer. The goal is to eventually minimize opioid use and establish consistent standards for all patients, said Jacob Moalem, M.D., a surgeon and director of quality improvement for Surgery.
“In our analysis so far, we’ve found a large number of patients who are discharged home with no narcotic medications whatsoever following major operations,” Moalem said. “This is incredibly encouraging. On the other hand, there are still opportunities for improvement in our use of these medications, and we’re working hard to create collaboration between patients, surgeons, and other care providers to reduce narcotic utilization across the Surgery Department.”
In another effort to combat narcotics abuse, last year URMC researchers were selected by the National Institutes of Health to take part in a nationwide program to develop non-addictive treatment for pain and carry out clinical trials. Leaders include: John Markman, M.D., director of the Department of Neurosurgery’s Translational Pair Research Program; Jennifer Gewandter, Ph.D., M.P.H., assistant professor in the Department of Anesthesiology and Perioperative Medicine; and Robert Dworkin, Ph.D., a professor of Anesthesiology and Perioperative Medicine, Neurology, and Psychiatry.
It also took teamwork to make strides in gynecologic oncology. Nurses did the research, Kugel said, but physicians, led by Cici Liu, M.D., assistant professor of Obstetrics and Gynecology, were on board immediately to make changes based on the data. Everyone is committed to educating new medical residents, other providers, and patients, Kugel said.
“We can play a role in controlling the opioid crisis,” Kugel said. “Patient education is so important. We tell them, up front, that mostly likely they will not leave the hospital with narcotics. We recognize that we all play a role in this crisis. By creating standardized practices and awareness, we’ve seen patients have improved their outcomes without opioids.”
The CDC reports that narcotics abuse and deaths are a public health crisis, killing more than 67,000 people in 2018, with 70 percent of the deaths involving opioids. Some people become addicted after they are legitimately given narcotics following a medical procedure. Today’s problems stem from a trend that began in the 1990s, according to the National Institute on Drug Abuse, when opioid prescriptions increased as pharmaceutical companies and doctors believed they were safe.