When it comes to acute, subacute and even chronic pain, opioid medications play an important role in helping manage one’s pain as they are often prescribed after a surgical procedure, injury or diagnosis of a drastic illness like cancer.
When it comes to acute, subacute and even chronic pain, opioid medications play an important role in helping manage one’s pain as they are often prescribed after a surgical procedure, injury or diagnosis of a drastic illness like cancer.
The impact of opioid misuse continues to be felt across the United States. According to the Centers for Disease Control and Prevention (CDC), nearly 80,000 overdose deaths in 2023 involved opioids, highlighting the importance of responsible prescribing and patient education.
Increased dependence and misuse are some of the many reasons why healthcare systems across the country, including Adventist HealthCare, are taking a closer look at how opioids are prescribed.
Ron Brathwaite, MD, a hospitalist who serves on the 2 East/Medical-Surgical Unit at Adventist HealthCare Fort Washington Medical Center, explains why limiting opioid prescriptions is more than just about helping patients recover safely—it's about protecting the well-being of community members at large, too.
Balancing Effective Pain Control: A Shift Toward Safer Prescription Practices
Opioids—such as oxycodone, hydrocodone and morphine—can be highly effective for short-term pain relief. However, even short courses can carry risks. According to Dr. Brathwaite, prescription limits are intended to reduce unnecessary exposure and minimize the chance that patients will develop long-term dependence.
The goal is not to deny pain relief, he said, but to strike a balance by using opioids only when needed, at the lowest effective dose and for the shortest duration possible. “For example, a post-operative patient may be unable to tolerate just Tylenol or Motrin for pain control. So, if we do have to use something like oxycodone, we use the lowest dose possible,” Dr. Brathwaite said. “If it’s not a post-operative patient, then typically we stick to Tylenol and Motrin, which both have been shown to be very effective for pain control.”
When it comes to evaluating past opioid use, Dr. Brathwaite emphasized the importance of obtaining collateral information about a patient’s medication history, particularly from outside pharmacies that can confirm previous doses and frequencies.
The Role of Opioid Education in Improving Outcomes
Dr. Brathwaite also highlighted that informed patients are better equipped to manage their recovery safely.
Taking the time to have an “honest and accurate conversation” with patients goes a long way, as clear instructions help reduce anxiety and prevent confusion about dosing or duration, he said.
“While in the hospital, it’s important to describe all the side effects and issues with opioid use. A lot of patients become very fearful and don’t want to be in pain,” Dr. Brathwaite said. “Reassurance plays a big role in making sure patients understand that even if we don’t use opioids to begin with, we’re still going to address their concerns and not leave them without any type of pain control.”
Dr. Brathwaite said there is a large population of senior patients who receive care at FWMC. Opioids can be very problematic for these individuals who may experience major side effects like confusion, worsening dementia, delirium and even constipation.
The likelihood of senior patients becoming lethargic increases with opioid use, resulting in other unwanted circumstances such as lack of physical therapy or a loss of appetite. “We have to be very careful with that,” Dr. Brathwaite said.
In the outpatient setting, Dr. Brathwiate noted that limiting prescribed opioids is part of a broader objective to protect the public’s well-being. .
“Making sure that we prescribe the minimum amount necessary is a great way of preventing potential opioid issues as an outpatient,” he said.
Disparities in pain management typically come into play with patients who have sickle cell, as these patients are oftentimes underdosed and their complaints about pain aren’t always taken seriously. “I mainly think of that patient population when it comes to in-hospital or inpatient medicine,” Dr. Brathwaite added. “Verifying and making sure that we’re paying attention to their pain medication needs are some of the things that go a long way with making patients feel secure, heard and seen.”
Tackling Barriers and Unforeseen Challenges
Research has shown that opioid misuse affects communities nationwide, contributing to ongoing trends in addiction and overdose crises.
“The start of their addiction could possibly be traced back to the hospital’s administration of such medications,” Dr. Brathwaite said.
Providing guidance on tapering off medications sooner, as well as placing more emphasis on alternative pain relief methods, helps to further support long-term recovery while concurrently reducing risks.
“Patients who have previously used or had some kind of experience with opioids tend to think that is the only way that their pain can be relieved, and in some cases, that may be true,” Dr. Brathwaite noted. “There has been a lot of evidence to suggest that most patients become addicted to opioids, and the reason they become addicted is because they were given opioids in the hospital or upon being discharged.”
Understanding Collaborations Across Care Teams
Primary care physicians (PCP) play a key role in filling prescriptions on a long-term basis, as hospitalists typically don’t do that. Patients should know that their PCP must be involved when long-term prescriptions are needed, and that there should only be one doctor prescribing them.
Dr. Brathwaite clarified that clinicians must provide clear discharge instructions for patients, which should include a note to communicate directly with their PCP or nurse practitioner about any further decisions regarding pain medication.
Otherwise, things can become very problematic if opioid prescriptions are not handled properly.
“For any clinician, seeing what your colleagues are doing is very important,” Dr. Brathwaite said. “Any opioid prescriptions have to be sent electronically, which allows for better tracking and also keeping databases up to date with prescribing habits. I think that’s probably one of the biggest things that has helped with the reduction [in opioid-related misuses and overdoses].”
Tracking opioid prescription habits via hospital scorecards is one of the biggest changes made recently, according to Dr. Brathwaite, especially because outside pharmacies no longer accept paper prescriptions for narcotics.
“We actually get a scorecard regarding how frequently we prescribe opioids,” he said. “We want to use the least amount possible, typically no more than a three-to-five-day course of narcotics. And then let the patient know that it should be used only as a last resort.”
After patients have been discharged, Dr. Brathwaite said their need for pain medication should decrease over time. If their dependence increases or does not improve, then that could result in readmission to the hospital.
“We don’t want to be part of that problem,” he said. “We want to make sure that we minimize that as much as possible.”
Key Takeaways
Opioid prescription limits are part of a broader effort to promote safer, more effective pain management. While these medications remain an important treatment option for many patients, careful prescribing practices, patient education and ongoing communication between healthcare providers and patients can help reduce risks while supporting recovery.
As Dr. Brathwaite emphasized, successful pain management begins with listening to patients, setting realistic expectations and creating a treatment plan that prioritizes both comfort and safety. When patients understand their options and providers work collaboratively across the continuum of care, better health outcomes become possible for individuals and communities alike.
