Dr. Mulholland on Newstalk1010
Speaker 1: … new research showing that thousands of plastic surgery patients get hooked on opioids after their operations. In a study of nearly 500,000 people who had gone under the knife, 50,000 went on to use the highly addictive painkillers for longer than needed. And apparently the highest risk was among breast job and tummy tuck patients, likely because those operations can often be more invasive and painful than others. As plastic surgery rates skyrocket, researchers warn these findings show a specific need for guidelines on opioid use before, during, and after plastic surgery.
Speaker 1: Joining us to talk about this is our friend Dr. Steven Mulholland, founder of SpaMedica and one of Canada’s top cosmetic plastic surgeons. Dr. Mulholland joins us on the line. You’re in Thailand?
Dr. Mulholland: I’m in Thailand, Barb. Spring break.
Speaker 1: What are you doing? Is it March break in Thailand?
Dr. Mulholland: No, March break for our kids. We have them at this eco reserve and sort of working in an orphanage and experiencing life from a different perspective.
Speaker 1: Oh, isn’t that interesting? Oh, did you want to tell us a bit about that before we go on to the story?
Dr. Mulholland: Well, I mean, it’s fascinating. And it’s quite advanced in some respects in management of the sort of Indian elephants. There used to be 300,000 of them a hundred years ago. It’s down to about 200 so we’re up in the north and working at a reserve and an after school sort of orphanage with kids that don’t have parents. So it’s quite communal and community oriented and I think it’s good for our kids to see that. We get quick locked up in our urban lives and it’s good to give kids a perspective at that age.
Speaker 1: I was going to say when I hear about students doing things like that, they often come back with prospective on what the world can be like for other people.
Dr. Mulholland: I think so. You know, the kids were grumbling on our way there, but they’re having a great time.
Speaker 1: I’m glad to hear it. I’m so glad. In terms of this story, so you are doing a lot of these procedures. Have things changed in terms of guidelines around opioid use and discussing it with patients?
Dr. Mulholland: You know, I think every jurisdiction is different, but there are some facts that remain for sure. Cosmetic surgery is definitely on the rise, a 1000% increase in the past 10 years. And one of the most common things we do are breast augmentation and of course, tummy tuck. And that involves working on the muscle. Many of our procedures, facelifts, upper lid, lower lid liposuction, it’s all mainly skin and under the skin and the fat. And that’s not terribly painful. Whereas some of these procedures that work on the muscle are painful. And then we’ve got a whole classes of new narcotics available that are very potent. And the addictive people can get addicted within a week, certainly postoperatively.
Dr. Mulholland: And then we’ve got some jurisdictions in Canada and abroad that don’t educate physicians as well as they should. And of course, patients are in pain and they’re addicted and they realized that, so they were requesting more narcotics. So it is a perfect and unfortunate crucible for addiction. And that’s what we have. Many patients get addicted to narcotics after their cosmetic plastic surgery and getting an addicted can be very difficult.
Speaker 1: So how do you go about managing that? Does that begin before the procedure?
Dr. Mulholland: It sure does. And so, at my clinic, and I think in Ontario we’re quite progressive because the College of Physicians and Surgeons of Ontario has made this commonly known. The Canadian Society of Plastic Surgeons has discussed it and is forwarding a policy. But in general, I meet with patients and I tell them, you know, it’s going to hurt and there’s some muscle pain and you’re going to get exactly 10 strong narcotics, 10 tablets, that’s it. And that will last you about four days. And we’re talking like Oxycontin, Oxycet the Oxy brand, which is very, very effective pain relief, but extremely addictive.
Dr. Mulholland: And after that we’re going to put you on to this new class of nonsteroidal antiinflammatory called Ketorolac or Toradol. Now unfortunately, this came from the UK. I don’t believe the UK has Toradol available orally. It’s very strong nonsteroidal antiinflammatory, stronger than Tylenol three with the old codine that we used to give all the time. But there’s no addictive, no constipation and no nausea side effects. And we can bundle that with some Gabapentin and other classes of non-narcotics after the first four days to keep people very comfortable. And if you do that, you just don’t have the addiction rates that clients and patients can get after a week or two on strong narcotics.
Speaker 1: This is not exclusive to cosmetic plastic surgery. We hear these stories with people who have any kind of surgery that that can often lead to an addiction to opioids. Do you think generally doctors are being careful enough when it comes to monitoring and managing the prescribing of opioids after surgery?
Dr. Mulholland: No, I think we’ve done a fairly poor job as surgeons as a whole. I mean the article picked on breast aug and tummy tuck because I mean, that has public sort of sound bite effect. Oh, you know, we’re creating these, you know, raving Oxy addicts after breast documentation. But the truth is that most addiction happens after surgery or chronic disease where a patient may have surgery but ongoing pain, particularly orthopedic pain, bone pain, spinal pain, cancer pain, inflammatory bowel disease pain. These are usually where patients are going to get addicted because even the surgery, the intervention, or the medical treatment doesn’t resolve the pain.
Dr. Mulholland: And then doctors are under pressure to treat pain. Which pain is a serious issue and it needs to be treated. And then unfortunately, the strong narcotics or opioids, which again are available without even seeing your doctor. So you know, $25 on the street for an Oxy. So patients may not even get the prescription from a doctor and they buy it in the street or they doctor shop and they go from one doctor to another and get multiple prescriptions. In Ontario we have a database that’s linked to the pharmacies and that has greatly reduced the doctor shopping. But some provinces and many jurisdictions in the US and the rest of the world don’t have that.
Speaker 1: Thank you so much for joining us. When are you back from Thailand?
Dr. Mulholland: About a week, but it’s really difficult with this 30 degree weather to get enough sunblock on, but I’ll try.
Speaker 1: All right, well, we’ll have to talk about how we’re going to deal with that the next time we see you. Dr. Mulholland, thank you.
Dr. Mulholland: Thank you. Thanks again. Bye Bye.
Speaker 1: Dr. Steven Mulholland, founder of SpaMedica is one of Canada’s top cosmetic plastic surgeons.