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Ahead of the marcus evans National Healthcare CXO Summit Spring 2017 and the 
National Healthcare CXO Summit Fall 2017, Dave Stack discusses the opioid epidemic, patient satisfaction and postsurgical pain management

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“As the healthcare industry moves towards value-based pricing, patient satisfaction and postsurgical pain management will play a greater role. Limiting opioids after surgery can have a measurable impact on patient outcomes and hospital economics,” says Dave Stack, Chief Executive Officer, Pacira Pharmaceuticals, Inc. “Unfortunately, given their low cost and high potency, opioids have remained the standard of care, and the operating room has become an inadvertent gateway to the opioid epidemic. Reducing or eliminating their use is a huge patient care and patient satisfaction opportunity for hospitals,” he adds.

Pacira Pharmaceuticals, Inc. is a solution provider at the marcus evans National Healthcare CXO Summit Spring 2017 and the National Healthcare CXO Summit Fall 2017.

What is challenging hospital CEOs with postsurgical pain management? 

In our experience, assessing how pain management relates to the overall cost of care can be challenging. It may be easy for hospital staff to provide certain pieces of information — like product acquisition cost, which is captured in the Pharmacy budget — while other data points (which are significant cost drivers) like PACU throughput or hospital length of stay may not be so easy to capture or assess. In the case of a knee replacement, reducing or eliminating opioid exposure can shorten a patient’s time to ambulation and physical therapy, thereby allowing for a more rapid discharge to home. These savings significantly offset product acquisition cost, but there are few mechanisms in place (and pharmacists are often not incentivized) to create the feedback loop necessary to adequately paint the complete picture of the continuum of care. This shortcoming results in decisions based on Pharmacy budget alone, often to the disservice of patients who are recovering better and with higher satisfaction with medications that might appear on a spreadsheet to be a higher cost.

On paper, opioids are inexpensive analgesics, so if all we are looking at is the cost of one medication over another, opioids will win nearly every time. But a look at their impact across the episode of care will tell a very different — and very costly — story. There are significant costs associated with treating opioid-related adverse events, such as urinary retention for example, which requires catheterization and often extends length of stay, but all too often, these costs go unnoticed because they do not align to the Pharmacy budget.

The opioid epidemic is the other big issue. The literature shows that one in 15 patients prescribed an opioid during surgery will go on to use these medications for six months or longer. In many cases, patients may not even realize they are taking an opioid, or that there are significant risks associated with these medications.

Why do you consider EXPAREL^® part of the answer?

EXPAREL is the only single-dose local analgesic shown to provide prolonged pain control with reduced opioid requirements during the critical postsurgical period when pain is at its worst. EXPAREL combines the common anesthetic bupivacaine (which essentially numbs the area in which it is injected) with our drug delivery technology DepoFoam^® to slowly release the medication over time. While traditional bupivacaine provides six to seven hours of pain relief, EXPAREL is effective for upwards of three days. Therefore, it is now possible to dramatically decrease the need for postsurgical opioids, and in fact, clinicians can increasingly perform a number of surgeries opioid-free.

For which patient populations are opioids especially problematic?

No patient does better on an opioid. They are potent pain relievers, but they cause side effects like nausea, vomiting, urinary retention, and so on. All individuals are at risk of experiencing these side effects, but certain populations are at higher levels of risk, including the elderly, obese patients and those with sleep apnea. There are reasons to avoid opioids after every surgery. After knee replacement for example, it is best for patients to mobilize as quickly as possible, but if they have taken a lot of opioids, that will impact how stable they feel on their feet. After an oncologic surgical procedure, opioids may downregulate the immune system and force clinicians to delay a therapeutic regimen.

Why is postsurgical pain control the key to improving patient outcomes?

We have taken care of most of the issues associated with poor surgical outcomes, but there is still a heavy reliance on opioids. By reducing the amount of opioids, we can mobilize patients sooner, reduce length of stay and reduce costs associated with treating adverse events. When patients feel better, satisfaction goes up. Everything is better if the patient does not have pain. Their surgeon is a better surgeon. Their prosthesis is a better prosthesis. If you control pain, everything involved in the process of surgical aftercare improves.