Should Hospitals Market Opioid-Sparing Analgesia to Patients?

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It has become impossible to ignore that the United States is suffering from an opioid epidemic. Numerous academic and news media publications have covered the subject, and the statistics used to describe the magnitude of the problem are staggering. Today, more US citizens die of opioid-related causes annually than those from human immunodeficiency virus and AIDS at the height of the epidemic in 1995.1,2 Most states have adopted some legislation designed to combat opioid abuse, which has involved requiring providers to consult Prescription Drug Monitoring Programs before prescribing opioids, as well as limiting both quantity and duration of prescription allowances.3 Massachusetts4 and Pennsylvania5 have passed legislation granting patients the right to formally opt out of opioid treatments during hospitalizations. American citizens are clearly showing more interest in addressing the opioid epidemic.
Hospitals in the United States routinely use direct-to-consumer advertising in order to compete in health care markets. It is estimated that the average US hospital spends $1.4 million annually on marketing6 and that collectively US hospitals spend more than $2 billion on advertisements per year.7 This is not isolated to private for-profit hospitals, as a survey found that 16 of the top 17 ranked academic medical centers had an active marketing department to attract patients.8 Hospitals often advertise services with high financial returns such as comprehensive cancer centers and robotic-assisted surgery.9 It is important to note that there are currently no studies that describe a correlation between marketing hospital services and an improvement in patient outcomes. However, there is reason to believe that advertising can have a measurable effect on patients' behavior and beliefs. An analysis of more than 2000 hospitals in the United States found that higher advertisement spending was correlated with an increase in patient satisfaction scores and willingness to recommend services in competitive health care markets.10
Marketing opioid-sparing regimens has the potential to succeed because it aligns the interests and objectives of patients, providers, and hospitals alike. First, hospitals benefit from the wide application of multimodal analgesia, as it readily applies to both the medical and surgical wards. When used in concert with Enhanced Recovery After Surgery (ERAS) pathways, patients experience shorter lengths of stay and lower rates of complication, outcomes that mutually benefit the patient and hospital together.11 Advertisement of opioid-sparing analgesia is likely to increase the volume of patients who receive regional analgesia, opening up the potential for more revenue streams and providing incentives for hospitals to invest in regional staffing and acute pain service resources. By advertising opioid-sparing analgesia, hospitals can target a growing consumer niche and lessen the impact of recent opioid-centric legislation. Patients are becoming more aware of the opioid epidemic and increasingly concerned regarding the routine use of opioids. Patients inherently want to support products that align with their own values and are willing to be scrutinizing in order to obtain the highest value available.
Multimodal analgesia uses multiple agents with alternative mechanisms of action to either prevent or control pain. Medications such as nonsteroidal anti-inflammatory drugs, gabapentinoids (eg, gabapentin, pregabalin), N-methyl-D-aspartate receptor antagonists (eg, ketamine, dextromethorphan), and intravenous local (eg, lidocaine) can be used in a simultaneous and even scheduled fashion to address nociceptive nerve impulses through several receptor subtypes. Another mainstay of multimodal regimens is the utilization of regional analgesia, where local anesthetic agent is injected adjacent to nerves networks, thereby temporarily impairing transmission and subsequent pain. The overall multimodal analgesia approach has been shown to limit the reliance upon perioperative opiates, decreasing both the adverse effects and various systemic complications associated with their use.

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