The prescription opioid epidemic: an overview for anesthesiologists

Abstract

Purpose The objectives for preparing this article were to review the historical context and epidemiology surrounding the North American prescription opioid crisis, to summarize the evidence regarding the benefits and harms of long-term opioid therapy for non-cancer pain, and to outline ways in which anesthesiologists may help ameliorate the problem. Source We searched PubMed, Google Scholar, and EMBASE TM for relevant articles using various search terms, including pain, opioid epidemic, history of opioid use, perioperative care, and addiction. Related citations were further explored and searched depending on the specific subtopic of interest. Principal findings In the 1980s and early 1990s, opioids were infrequently used for the treatment of chronic pain. Thereafter, however, physicians were gradually inculcated with the message that long-term opioid therapy was a safe and effective treatment option for patients with chronic non-cancer pain. Pharmaceutical companies supported this growing movement and employed aggressive and sometimes misleading marketing strategies for new opioid formulations. As a result, the practice of prescribing opioids flourished in the late 1990s. The surge in prescribing opioids was accompanied by a marked increase in opioid-related morbidity and mortality. This change in practice transpired despite the absence of randomized trials showing clinically significant benefit from the long-term use of opioids. Subsequently, however, a large and growing body of evidence has emerged quantifying the harms associated with long-term opioid therapy. Anesthesiologists widely prescribe opioids for acute and chronic pain; yet, as a group, they may be largely unaware of the current state of this growing epidemic and what role they can play to rectify this problem.Conclusion Anesthesiologists are well positioned to take a leadership role in the management of postoperative discharge opioid therapy in an effort to curb the overutilization of opioids. Furthermore, anesthesiologists who regularly prescribe opioids for chronic pain patients should appreciate the limited evidence base for this practice and communicate the risks of opioid therapy to their patients.

Comparative Echogenicity of an Epidural Catheter and 2 New Catheters Designed for Ultrasound‐Guided Continuous Peripheral Nerve Blocks

“…Given the current opioid epidemic and association between surgery and long‐term opioid use, it is more important than ever to maximize the use of nonopioid analgesic techniques to manage pain. A continuous peripheral nerve block provides targeted delivery of a local anesthetic directly to a nerve or plexus via a “perineural” catheter .…”

Liberal long‐term opioid prescription – more pain than gain?

“…8 In the United States and Canada, the problems with prescription opioids for non-cancer pain have reached epidemic proportions. 9,14 Danish physicians involved in pain and palliative medicine have been very concerned about the undesirable effects of the liberal opioid prescription policy, and have characterized the practice as 'prescription for problematic opioid use'. In Finland and Iceland, opioid practice has been stricter.…”

“…3,11-13 As a consequence, Denmark has the third highest use of strong legal opioids in the world, and if weak opioids are also taken into account, the total opioid consumption per capita in Denmark is approximately as high as in United States and Canada. 9,18 Recent meta-analyses on opioids for chronic non-cancer pain have not been able to show any clinically important long-lasting improvements in average pain intensity. [11][12][13] It is time to face the fact; the opioid prescription epidemic is not a specific North-American problem, it is a rich national phenomenon involving Scandinavia to an inconvenient degree.…”

“…8 In the United States and Canada, the problems with prescription opioids for non-cancer pain have reached epidemic proportions. 9,10 Among the Nordic countries, Denmark has had the most liberal opioid prescription policy during the last several decades. In Finland and Iceland, opioid practice has been stricter.…”

“…3,13 A liberal opioid prescription policy results in an increased societal opioid-exposition and dramatically increases the risks for abuse, addiction, non-medical use, increased morbidity, serious events and even death. 9,14 Danish physicians involved in pain and palliative medicine have been very concerned about the undesirable effects of the liberal opioid prescription policy, and have characterized the practice as 'prescription for problematic opioid use'. 8,15 How could this happen?…”