“Prescription drug overdose is an epidemic in the United States. All too often, in far too many communities, the treatment is becoming the problem.” ¹

80% of patients experience acute pain after surgery.

75% of U.S. patients report surgical pain rated 7 or higher (scale of 1–10).

59% of patients are concerned about postoperative pain. ²

November 2016: U.S. Surgeon General declares epidemic of addiction—public health crisis ³

United States contains 4.6% of the world’s total population, but consumes two thirds of the world opioid supply.

12.5 million people, or 4.7% of the American population, aberrantly used prescription opioids in 2015. ⁴

1% of the U.S. population is addicted to opioids.

2015: 28,647 people died in the United States due to prescription opioid overdose

Prescription opioid use disorder is estimated to cost the American economy $53.4 billion per year.

Resurgence of heroin

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  Cheaper

  
  
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  Inappropriate weaning strategies from prescription opioids

Four fifths of heroin users report their initial exposure to opioids was to prescription opioids. ⁵

2007: Prescription opioid overdose responsible for more deaths than heroin and cocaine combined ⁶

1996–2006: Rate of prescription opioid use disorder increased by 167% ⁷

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  Rates continued to rise

Surgeons responsible for 9.8% of the total opioid prescriptions in the United States ¹⁵

Rates of opioid prescriptions to opioid naive patients after minor surgery increased between 2004–2012. ¹⁶

Surgeons may play a significant role in propagating the addiction crisis by exposing patients to potentially harmful and addictive opioid medications and contributing to the street supply of opioids.

Simple education interventions for patients to explain how to safely store and dispose of opioid medications can make a significant impact.

Led by the surgeon and a written handout or referral to a website which explains proper opioid storage and disposal

Opioids should be stored in a locked cabinet.

All unused medication should be returned to the pharmacy or destroyed once postoperative pain has resolved.

Patients who were opioid naive before surgery shown to have a significant chance of persistent postoperative opioid use. ¹⁷

Many patients continue to receive opioids chronically after initially receiving them for postoperative pain control.

Patients taking opioids chronically prior to surgery have an increased chance of still taking them 1 year later when compared with controls.

Consider the risk that an individual patient may develop persistent opioid use and proceed to an opioid use disorder.

Consider the risk that medications prescribed postoperatively may end up diverted to nonmedical use and causing direct public health harm.

Identify risk factors:

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  Psychiatric illness

  
  
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  History of either aberrant substance use or diagnosed substance use disorder

  
  
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  Communicate to the patient in a nonjudgmental way so that they can exercise caution in taking prescribed medications.

Patients with an established or suspected substance use disorder should be referred to an addiction specialist preoperatively if possible. ²⁵

Elective surgery in patients with established substance use disorders should not be performed until follow-up for substance use has been arranged.

Efforts should be made to explain and facilitate the use of nonopioid pain control.

Prescriptions should be limited to 20 doses of low potency, immediate release opioids unless circumstances clearly dictate otherwise. ^{26 , 27}