British journal of anaesthesia
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Br J Anaesth
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Review
The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse.
Why should I care?
Misuse of opioids is a growing global problem, well established in the US and quickly appearing in many high-resource countries. One person dies every 15 minutes in the US from opioid overdose.
For many affected, the perioperative period is the first exposure event. In the US ~6% of previously opioid-naive patients progress to persistent opioid use after surgery.
What can anaesthetists and anesthesiologists do?
- Identify patients at risk of opioid dependence.
- Use multi-modal non-opioid analgesia perioperatively.
- Educate patients on realistic expectations for post-operative pain.
- Consider regional techniques intraoperatively when appropriate.
- Limit discharge prescribing of opioids (42-71% of all postop opioid tablets go unused!).
The bigger picture...
Although inidividual practice changes are important, real impact will come through anesthesiologists as integrators of care (eg. ERAS interventions) and contributions to institutional strategies, patient and provider education.
Take a long view, this problem is not going away in a hurry...
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