Anesthesiology and pain medicine should play a leading role in developing effective alternatives and solutions to the U.S. opioid crisis, according to the November issue of Anesthesia & Analgesia, a special thematic issue presenting information on the “background, problems, and possible solutions to the opioid epidemic.”
The special issue, which was announced in an October 23 press release, presents research reviews and expert commentaries on the opioid crisis, focusing on the role of anesthesia and pain medicine physicians who care for patients undergoing surgery and those in need of specialized pain clinic care. Guest Editors Honorio Benzon, MD, a professor at the Northwestern University Feinberg School of Medicine in Chicago, Illinois, and T. Anthony Anderson, MD, PhD, a professor at Stanford University School of Medicine say they wanted to show the medical community that anesthesiologists have a critical role in identifying and solving the issues.
The opioid epidemic has reached crisis proportions. Even though opioid prescriptions have declined in the last few years, the number of opioid-related deaths has remained constant. Benzon and Anderson cite a report that states in 2015, there were nearly 90 opioid overdose deaths each day in the United States, primarily from unprescribed opioids.
Anesthesiologists and pain medicine physicians prescribe the most opioids, followed by surgeons and physical medicine and rehabilitation physicians. Spinal pain and chronic pain are two of the most common diagnoses leading to initial opioid prescription. “These are the patients we see in the pain clinic,” Benzon and Anderson note in their report. “We are the leaders in opioid prescription…and should take the lead in solving the problem.”
The special issue includes a series of targeted reviews, assembling current evidence in areas essential to developing solutions to the opioid crisis. The review topics include:
- Alternatives to opioids for chronic pain.
- Integrative medicine in pain management.
- Chronic opioid use after surgery.
- Opioid-sparing strategies.
- Emerging opioid and non-opioid medications.
The guest editors outlined the steps anesthesia and pain medicine clinicians can take to help reduce the opioid epidemic. For surgical patients, steps can include preoperative assessment to identify patients at risk and enhanced recovery protocols to reduce the risk of persistent opioid use after surgery. “As perioperative physicians, we can influence the culture of opioid overprescription,” they write.
Benzon and Anderson believe the special issue will provide a valuable evidence base for developing effective strategies for responding to the opioid crisis. As the primary drivers in the pain clinic and gatekeepers in the perioperative setting, they say, anesthesiologists should take the lead in identifying solutions to this problem.
“Measures necessary to combat nonessential opioid consumption…should be balanced with the legitimate needs of patients in pain.”