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Archive September 2020 XXI, No. 9

Anesthesia Alert: Caring for Patients With Opioid Use Disorder

Commit to the extra effort and attention needed to manage their post-pain.

Tom Baribeault

Tom Baribeault, CRNA


BETTER OPTION A judicious use of regional blocks is one effective way to avoid using opioids for these high-risk patients.

More than 2 million Americans suffer from opioid-use disorder — and that might be a conservative estimate. This has led to a dramatic increase in patients presenting for surgery who are illicitly using opioids or in recovery from a problematic pattern of opioid use. Don't fall into the trap of treating these individuals like opioid naïve patients. Improving pain management protocols for patients with opioid use disorder will lead to vast improvements in the care they receive, save lives and protect the sobriety they have worked so hard to rebuild. 

1 Understand the risks

Surgery is an especially stressful time for patients with opioid use disorder. They worry about the success of the procedure and complications from anesthesia like everyone else, but also face the risk of relapse from exposure to opioids given during or after surgery.

In addition, opioid use disorder causes changes to the nervous system that make providing anesthesia and managing pain particularly challenging. The American Psychiatric Society lists some of the symptoms of opioid use disorder as increased tolerance to opioids and sensitivity to pain. Additionally, the standard treatment for opioid use disorder includes medication-assisted therapy, which includes buprenorphine/naloxone or naltrexone. These medications block the opioid receptors and make using opioids to treat pain even less effective.

It's clear opioids aren't effective at controlling pain in patients with opioid use disorder. It's also ethically unsupportable to expose them to the drug of their addiction without first exhausting all other efforts at controlling their pain.

2 Improve communication

Care of the patient with opioid use disorder is still a subjective area that must be guided by the best evidence of addictionology, pain management and anesthesiology.

Surgical professionals are often slow to adapt and with the stigma surrounding opioids today, many providers don't screen for opioid use disorder. Ideally, surgeons should screen patients during initial clinic visits, and alert surgical facilities and anesthesia teams when surgeries are scheduled for patients with the disorder.

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