I have been studying how much pain medication to give after surgery by giving all of my patients a questionnaire 10 days out from surgery. What have I found from my questionnaire? That everyone is all over the place. Some take only a few pills, others come in asking for something stronger. Some use all of their medication. Some use almost none.
The issue is we see such a wide variety of pain after surgery. Last week I had two patients I did abdominoplasty (tummy tucks) surgery on. For a tummy tuck I come at the pain from many different directions: I use Exparel, which a long acting numbing medication which I inject during surgery. I use muscle relaxants, as the majority of the pain is from the muscle tightening. But I still need a pain pill, and one which cannot increase the risk of bleeding. So I need to prescribe an opioid. For these two patients, one of them took ONE pain pill after surgery. That was it. The other came in a day after surgery saying her pain had not gotten below a level of 7 /10. I had to give her something stronger.
With the opioid epidemic, we don’t want to overprescribe medication. We plastic surgeons cannot use many great pain relievers (like Advil, Naprosyn, and others) because they increase the risk of bleeding. So we prescribe opioid medication. National regulations now limit most prescriptions to a 7 day supply. I think this is good- you don’t want to build a tolerance, and you should not be on them for a long time. In plastic surgery, almost all surgery is an acute pain. Surgery happens, you heal, pain ends.
How do we know how much to give? We don’t. We guess. And that may mean you have pills left over.
The DEA has started a medication take back day, which happens three times a year. It is a great idea- Don’t leave those extra medications in your cabinet (where friends or your kids could access them). Don’t flush the medications down the toilet, where they can poison our water system. Instead, take them to a site where they can be processed correctly.
BUT for those who are not having surgery around the times of the national takeback day, there are local pharmacies which will take back your unused medication. I looked up those within a 20 mile radius of my Palo Alto office, and I was heartened to see so many sites. I copy and pasteed a partial list below. Most Longs Drugs, Walgreens, Kaisers, and major hospitals all have centers. For a more extensive list, click the link HERE.
Public Controlled Substance Disposal Locations:
STANFORD HEALTH CARE PHARMACY
875 BLAKE WILBUR DR STE CC1102 PALO ALTO, CA 94305
WALGREEN CO.
300 UNIVERSITY AVE PALO ALTO, CA 94301
MAXIMART PHARMACY
240 CAMBRIDGE PALO ALTO, CA 94306
LONGS DRUG STORES CALIFORNIA, L.L.C.
352 UNIVERSITY AVE PALO ALTO, CA 94301
LONGS DRUG STORES CALIFORNIA, L.L.C.
2630 W EL CAMINO REAL MOUNTAIN VIEW, CA 94040
GARFIELD BEACH CVS, L.L.C.
700 EL CAMINO REAL MENLO PARK, CA 94025
LONGS DRUG STORES CALIFORNIA, L.L.C.
2701 MIDDLEFIELD RD PALO ALTO, CA 94306
NOWRX 2224 OLD MIDDLEFIELD WAY STE J MOUNTAIN VIEW, CA 94043
DREW CENTER PHARMACY
2111 UNIVERSITY AVENUE P.O.BOX 51216 EAST PALO ALTO, CA 94303
LONGS DRUG STORES CALIFORNIA, L.L.C.
1041 EL MONTE AVE MOUNTAIN VIEW, CA 94040
KAISER FOUNDATION HEALTH PLAN
KFHP PHARAMACY #421 555 CASTRO STREET
MOUNTAIN VIEW, CA 94041
EL CAMINO HOSPITAL OUTPATIENT PHARMACY
2500 GRANT ROAD SUITE 1B20 MOUNTAIN VIEW, CA 94040
VALLEY HEALTH CENTER AT SUNNYVALE PHARMACY
660 SOUTH FAIR OAKS AVENUE
SUITE 1057 SUNNYVALE, CA 94086
JADE 2 PHARMACY
10133 S DE ANZA BLVD CUPERTINO, CA 95014
SAN MATEO MEDICAL CENTER
222 W. 39TH AVE SAN MATEO, CA 94403