Zucker School Medical Student Joins with NWH Against Opioid Abuse

America's opioid crisis has been steadily mounting over the past 20 years, claiming hundreds of thousands of lives with it. As a future anesthesiologist, Justin Diamond, a fourth-year medical student at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, welcomed the opportunity to be a part of the solution. Physicians at Northwell Health's Northern Westchester Hospital in Mount Kisco, NY, invited Diamond to co-author a study that would become the community hospital's first step in combatting the opioid epidemic locally. The study, published in the May 2021 Journal of Opioid Management, involved over 300 patients treated at the facility's Ambulatory Surgery Center (ASC) during three months and the participation of surgeons and nurses from across multiple specialties.

"The study will help Northern Westchester physicians gain deeper awareness into prescribing practices and the amount and type of pain medication used by patients," explained Diamond, who hopes to begin his residency in anesthesiology after graduating in May 2022. "It's also important to make patients aware that they are not required to take all of the prescribed pain medication if their pain is adequately controlled."

The Centers for Disease Control and Prevention (CDC) reports the most common drugs involved in prescription opioid overdose deaths are methadone, oxycodone, and hydrocodone. According to the study's lead investigator, Warren Bromberg, MD, FACS, director for the Center for Robotic Surgery, and chief, Division of Urology at Northern Westchester Hospital, the team's local findings are consistent with other nationwide studies published on opioid prescription and use. "We found that, on average, patients only consumed one-third of the prescribed opioids, yet they had very high [pain] satisfaction scores," explained Bromberg, also noting that very few patients called for additional opioids. "Many patients in the study specifically looked to non-opioid options to relieve pain post-surgery."

Dr. Bromberg points out that nationally published data reveals surgeons prescribe 10% of the opioids in this country, and 2-6% of patients prescribed opioids may be at risk of becoming chronic users. With over 50 million ambulatory surgeries performed annually in the US, approximately 2 million patients are at risk for persistent opioid use. The findings in the local study corroborate with nationwide studies indicating a wide variation of prescribing practices by physicians across states without widely accepted, evidence-based, post-operative opioid prescribing guidelines. Dr. Bromberg is currently working with administrators at Northern Westchester Hospital to develop a model for prescribing standards and patient education that will help lead the way for hospitals across the country.

"We have culled the literature and combined the data with our study and are in the process of creating prescribing guidelines for all surgeons within the ASC," explained Dr. Bromberg, adding that the focus at his hospital is on physician and patient education." We are creating brochures for our patients for perioperative pain management that include non-opioid pain management options. We are also evaluating several options for convenient disposal of unused opioids for our patients."

Initiatives to bring prescribing practices in line with patient opioid usage, such as those implemented at Northern Westchester Hospital, will help reduce medication waste, the cost of care and decrease the risk of medications ending up in the wrong hands. "The opioid epidemic has caused a lot of suffering and death," said Diamond, who recognizes that unused prescribed opioids pose significant health consequences. "I would like to see guidelines for surgeons in the future so more opioid pain medications don't end up in kitchen cabinets, where they can be unnecessarily diverted into the community."

The study is the first published by Diamond, who learned about the project while shadowing at Lenox Hill Hospital in New York City. "As a Zucker School of Medicine student, I'm incredibly fortunate to have access to a large health network with so many different physicians," said Diamond, who hopes to match with a residency program in New York. "It's essential for us to learn in medical school how to conduct research and present it in articles. It's an important skill that can only be acquired through practice."