Opioid Safety After Surgery

At HSS, our goal is to manage postsurgical and chronic pain safely and effectively, while minimizing the risks of opioid use. Before surgery, your surgeon will consult with your clinical team to determine the best approach to pain management for your recovery. When it comes to surgery and opioids: 

  • our surgeons and anesthesiologists are experts in a variety of pain-management treatments and therapies.
  • when possible, we seek to reduce or eliminate patients’ exposure to opioid pain medications before and after surgery.
  • your surgeon may recommend that you have preoperative consultations with other services that specialize in surgical pain management.

View each section below to learn more about how HSS optimizes opioid use for surgical patients and how to use opioids safely, including tapering off and disposing of opioids.

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Opioid Use For Surgery

Opioid Use For Surgery

Prior to surgery: You will receive education on the various aspects of the surgical process, including opioid prescription management. This includes information on how to take your opioids, your prescriptions, and what to expect from your medications.

Patients with a history of opioid use may be referred to our Chronic Pain Consult team for further evaluation. Long-term opioid use impacts anesthetic and pain management options and requires further evaluation to ensure the highest quality of care.

Day of surgery: You will have the opportunity to discuss anesthetic and pain medicine options with the anesthesiologist and surgeon before the anesthetic plan is set. All medications and information will be confirmed.

Managing Pain for Adults and Children

For adults: Learn more about what to expect for surgical pain management in our Anesthesia and Pain Management FAQs and by watching the following video:

For children: Children and teens require careful supervision using opioids. Read about Managing Pain in Children and Pediatric Anesthesia and Pain Management and watch the video below:

 

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How to Use Opioids Safely

How to Use Opioids Safely

Misuse and Overdose Risks

When misused, prescription medications may be just as dangerous as illegal drugs.

  • Misusing your medications can have serious consequences including lack of energy, inability to concentrate, physical weakness, nausea, vomiting, and suppressed breathing to the point of death. If you have not taken your medications as directed, and you experience any of these symptoms, please go immediately to an emergency room.
  • Misuse may also lead to addiction and accidental overdose – it is imperative that you take your medications only as prescribed. If you feel that you have taken more medication than what was prescribed, seek immediate medical attention.
  • As you recover from surgery your opioid use should decrease. If severe pain persists or your opioid requirements increase, please notify your surgeon.

Opioid Prescription Safety Tips

  • Take your medications only as directed by your doctor. DO NOT share your medications with anyone - sharing your prescriptions is illegal and could endanger other people’s health.
  • If you are taking benzodiazepines (Xanax, Valium, etc.), consult with your prescriber on the management of these medications with opioids. Combining opioids with these medications can slow or stop breathing. DO NOT mix opioid medications with alcohol. Do not drive or operate heavy machinery.
  • Store your prescriptions securely in their original containers. Keep them out of sight and out of children’s reach, preferably in a locked cabinet or high shelf.
Watch our helpful video on safety tips:

 

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Opioids and Benzodiazepines

Opioids and Benzodiazepines (Anxiety Medications)

While opioids and benzodiazepines (sometimes called “benzos”) can be important for treating pain, anxiety and other health conditions, taking them at the same time can put you at increased risk for accidental overdose. 

If your doctor permits you to take opioids and benzodiazepines at the same time, there are some safety practices you should know.

How to Reduce Your Risk

  • Talk to your doctor about the risks and benefits of using these medicines.
  • Ask your doctor if there are safer medicines to use instead, or if you can slowly reduce your doses.
  • Never combine opioids with other substances that can suppress breathing, such as sleep aids, alcohol, marijuana, or other drugs.
  • However, don't stop taking medicines without talking to your provider first. Stopping medicines too quickly can also cause serious problems, including withdrawal symptoms. 
  • Some medical conditions such as sleep apnea can increase your risk of complications or accidental overdose.
  • Consider getting Naloxone in case of emergency. Ask your pharmacy how you can get Naloxone.
Read the article Safety Practices for Taking Opioids and Benzodiazepines at the Same Time and watch our video below to learn more about best practices for opioid-benzos safety, and to learn what you should ask your doctor.

 

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Tapering Off Opioids

How to Taper Off Opioids

You will eventually need to slowly reduce and stop taking opioids. This is called “tapering.” Every patient’s experience with opioids is different. If you only take opioids for a short amount of time, you may be able to stop taking opioids without tapering. It is best to learn about all the possibilities so you can figure out what is right for you, based on your experience and your body’s reaction to these pain medicines.

For more information about tapering, visit A Patient’s Guide to Opioid Tapering and watch the following video on How to Taper off Opioids After surgery.

 

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Opioid Disposal

How to Dispose of Unused Opioids

  • Dispose of opioid medications immediately after your pain symptoms have resolved.
  • Unused medications are best disposed of at a take back facility/pharmacy – search for public disposal locations.
  • HSS also has a medicine disposal drop box on our main campus in the Belaire Building at 525 East 71st Street in New York City.
  • Patients discharged from HSS with an opioid prescription will receive DisposeRx® powder to safely and easily dispose of unused opioids.

Please see the following video for more information about opioid disposal, including instructions on how to use the DisposeRx® powder:

 

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How to Use Naloxone

Prepare for Emergencies: How to Use Naloxone

Naloxone is a medicine used to reverse opioid overdose. Just as someone with allergies might carry an EpiPen, or someone with diabetes may carry Glucagon, Naloxone is meant for emergencies and can save lives.

Naloxone only works on opioids, including heroin, fentanyl, and prescribed opioid medications. 

Signs of an overdose can include:

  • A pale or clammy face
  • Small, constricted “pin-point” pupils
  • Limp body
  • Blue or purple fingernails or lips
  • Gurgling noises or vomiting
  • The person is difficult to wake or is unable to speak
  • The person’s breathing or heartbeat slows or stops

Learn How to Use Nalaxone (Narcan) to Reverse an Opioid Overdose and watch the video below:

 

Opioid Prescription Policy

Hospital for Special Surgery prescribes opioid medications conservatively. We do not routinely prescribe long-acting opioids. We do not prescribe more than a short-course of short-acting opioids, and in general, we do not refill lost, stolen, or destroyed prescriptions. Review our Opioid Prescription Policy.

Learn more about how HSS is addressing the opioid crisis through policies, guidelines, best practices, education and continuing research.