setting, as well, although CMS hasn't yet said one way or the other.
Fighting the next wave
Finally, I want to make it clear that I'm not against opioids in all situa-
tions. Some people with chronic pain can function despite being
addicted to opioids. They can hold down a job, drive a car and live
their lives. Opioids also have a place in the management of cancer
patients. I'm certainly not advocating eliminating them from our socie-
ty.
What I am advocating is trying to minimize the next wave of patients
who have the potential to become part of this crisis. Most patients will
tell you the same thing: They started taking opioids and really didn't like
the way they felt, so they stopped. But the ones who get addicted will
tell you, "I took my first pill and I felt great!" Their bodies and their
brains light up, and then we see patients who go through 40 pills in 3
days and are already asking for more.
The problem is there are no identifiable markers — no way to pre-
dict who those susceptible patients are. I choose to try to make my
patients as opioid- naive as possible. I minimize the exposure upfront,
and then we never have to find out. We now have the capability to do
that — to control pain without relying on opioids, to throw away the
script.
OSM
4 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 9
Dr. Sigman (sasigmanmd@verizon.net) practices at the Drum Hill Surgery
Center in North Chelmsford, Mass., and at Lowell General Hospital.
Editor's note: Dr. Sigman has consulting agreements with Pacira Pharmaceuticals and
with DePuy Synthes, a subsidiary of Johnson & Johnson.
