Reducing Opioid Misuse After Surgery

Opioid misuse continues to claim the lives of many Americans, with drug-overdose deaths breaking records during 2020. Although the COVID-19 pandemic has contributed to these high rates, surgery is an often overlooked cause of the ongoing opioid epidemic, theAmerican Society of Anesthesiologists noted in a recent statement.

Approximately 94,000 overdose-related deaths were recorded in 2020, 30% more than in 2019, according to data from the Centers for Disease Control and Prevention (CDC).

“Overdose deaths from synthetic opioids (primarily fentanyl) and psychostimulants such as methamphetamine also increased in 2020 compared to 2019. Cocaine deaths also increased in 2020, as did deaths from natural and semi-synthetic opioids (such as prescription pain medication),” CDC stated.

Clinicians can help reduce opioid misuse after surgery by implementing the following factors, according to the ASA:

• Prescribing prehabilitation: Prehabilitation ensures that patients are prepared for surgery using patient-specific lifestyle changes such as exercising, reducing stress, improving diet, and quitting smoking. The goal is to optimize patient outcomes and recovery postsurgery as well as to reduce opioid reliance.
• Preoperative pain management: Patients with chronic pain may benefit from consulting with a pain medicine specialist before surgery to treat any pain that is unrelated to the indication for surgery (eg, back pain resulting from impaired gait in a patient with knee osteoarthritis). Non-opioid alternatives for pain control noted by the ASA include peripheral nerve stimulation, percutaneous interlaminar decompression, and injections or nerve blocks.
• Ensuring access to naloxone after surgery: Patients who are prescribed opioids after surgery may be at risk for accidental overdose, particularly those with respiratory issues, alcohol consumption, or who take medications that may affect breathing. Patients considered to be at increased risk for overdose should be prescribed naloxone.  

The ASA called for greater awareness of these presurgical methods to avoid opioid overuse after a procedure.

References

1. American Society of Anesthesiologists. Pain medicine specialists innovate to tackle America’s ongoing opioid epidemic by reducing misuse after surgery. August 25, 2021. Accessed September 29, 2021. https://www.asahq.org/about-asa/newsroom/news-releases/2021/08/pain-medicine-specialists-innovate-to-tackle-americas-ongoing-opioid-epidemic

2. Center for Disease Control and Prevention. Drug overdose deaths in the US up 30% in 2020. July 14, 2021. Accessed September 29, 2021. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20210714.htm

This article originally appeared on Clinical Advisor