Archive Anesthesia 2016

Anesthesia's Role in Curbing the Opioid Epidemic

Q&A with Asim Alam, MD, FRCPC, DRCPC, anesthesiologist and opioid-use researcher.

Outpatient Surgery Editors

BIO

Asim Alam, MD, FRCPC, DRCPC

How widespread is the misuse of opioids?
Studies have suggested that the problem may be plateauing or potentially improving in the United States, but other data suggest that it may actually be getting worse. It depends on where you live. I believe that anesthesiologists have only recently become aware of the problem and are now helping to solve issues that may arise from inappropriate opioid prescribing.

What factors have upped opioid use among surgical patients?
There is an increased long-term use in patients who initiate opioid therapy shortly after undergoing low-risk surgery. Whether this use is problematic or associated with long-term consequences is debatable. The association does show that the perioperative period has the potential to contribute to the ongoing epidemic. We should be aware of this phenomenon.

How prevalent is the use of opioids following surgery?
In one study, opioid-naïve patients who received an opioid within a week of surgery were 44% more likely to use opioids over the long term than those who did not receive prescriptions.

Does that create a potential problem?
There is some evidence suggesting that extra opioids, perhaps from post-op prescriptions, can be diverted or used inappropriately by patients after their pain has ended. The practice of giving standard prescriptions of exorbitant amounts of moderate- to high-strength opioids has to stop.

But opioids are still valuable options in pain management, right?
Yes, they definitely have a role to play. The idea is not to scare practitioners away from prescribing opioids, but to enable them to provide suitable limited opioid prescriptions based on the patient and surgery type. However, anesthesiologists should be aware of the epidemic surrounding the over-prescribing of opioids and take steps to mitigate inappropriate discharge prescriptions. Patient education is also important. A center in Canada provides patients with pamphlets on proper use of opioids and has realized promising quality improvement results. That's a tool that could be incorporated in any outpatient facility. OSM

Dr. Alam (asim.alam@sunnybrook.ca) is a staff anesthesiologist and transfusion medicine specialist at Sunnybrook Health Sciences Centre and an assistant professor in the department of anesthesia at the University of Toronto. He co-authored a study in the January 2016 Canadian Journal of Anesthesia (osmag.net/gvYTJ4) about the prescription opioid epidemic.

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