美国国家公共电台 NPR Should Hospitals Be Punished For Post-Surgical Patients' Opioid Addiction?（在线收听）

LINDA WERTHEIMER, HOST:

There's an emerging movement to hold hospitals accountable for people addicted to prescription opioids resulting from a hospital stay.

From member station WBUR in Boston, Martha Bebinger reports.

MARTHA BEBINGER, BYLINE: Katie Herzog's withdrawal symptoms began about a month after back surgery. The 68-year-old consulting firm CEO had the surgery in April at a prominent Boston hospital.

KATIE HERZOG: I had sort of almost, like, bone spurs growing into my spine. And there was no room left in the spinal canal for spinal fluid at all.

BEBINGER: The surgery lasted nine hours. Hertzog left the hospital with a prescription for Dilaudid, an opioid used to treat severe pain and instructions to take two every four hours as needed. She took the full dose for about two weeks, then began worrying about addiction.

HERZOG: I said, how do I taper off this? I don't want to stay on this drug forever. You know, what do I do? And I never got any clear answer. The visiting nurse would say well, whatever your doctor says. The internist says, what does the surgeon say? You know, the surgeon doesn't do medicine. It was his resident or somebody else in his group who did it.

BEBINGER: When none of these people explained how to go off the Dilaudid, Hertzog found a Canadian guide to tapering opioids. Hertzog tracked her progress milligram by milligram in a pocket diary.

HERZOG: So I started tapering from 28, 24, 16. I can show you, you know, all the way that I went down.

BEBINGER: Her one month post-surgery appointment coincided with Herzog's first day off Dilaudid. By the time she got to the doctor's office, Hertzog was sick.

HERZOG: I was teary. I had diarrhea. I was vomiting a lot. I had muscle pains, headache. I had a low-grade fever. The surgeon said, I think you have a virus. You should go see your internist. And the P.A. was there, and she thought so too.

BEBINGER: So Hertzog went home thinking she had the flu and suffered through five days of what she came to realize was withdrawal.

HERZOG: I had every single symptom in the book, and there was no recognition by these really professional, senior, seasoned doctors that I was going through withdrawal.

BEBINGER: Herzog isn't naming any of her five or more doctors and nurses at two hospitals because she sees her case as a system-wide problem.

Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, says many physicians don't recognize withdrawal because they do not realize how quickly a patient can become dependent on pain meds.

ANDREW KOLODNY: A patient who takes an opioid a few times a day for as little as one week is going to begin to develop physiological dependence on the drug, which means that they're likely to feel symptoms when they try and come off.

BEBINGER: Sometimes that dependence triggers full-blown addiction. Now, a handful of doctors and hospital administrators are asking, if an opioid addiction starts with a prescription after surgery or some other hospital-based care, should the hospital be penalized as they are for infections and readmissions? Is addiction a medical error?

Kolodny likes the idea.

KOLODNY: It might help promote more cautious prescribing. It might help change practice.

BEBINGER: But penalizing hospitals for addiction may conflict with payments tied to patient satisfaction surveys that ask, did your hospital address your pain? Dr. Gabriel Brat is a trauma surgeon with the Harvard Medical School.

GABRIEL BRAT: This is a real concern that patients who may feel that their pain is undermanaged may take that out as it were in these patient report cards.

BEBINGER: Which may be one reason three of four post-surgery patients had leftover opioid pills according to a recent study. Dr. Brat says only about 10 percent of patients need lots of pain meds, but doctors can't tell who they are.

BRAT: Many surgeons are still prescribing opioids for the subset of patients that have higher requirements as opposed to, for the majority of the patients who often aren't taking a very small percentage of the pills that they're prescribed.

BEBINGER: As Hertzog discovered, there are no set guidelines for which opioids to prescribe after surgery at what dose and for how long. And there are no protocols for helping patients ease off pain meds and cope with withdrawal.

For NPR News, I'm Martha Bebinger in Boston.

WERTHEIMER: This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

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