The rising tide of opioid use and abuse: the role of the anesthesiologist

Abstract

The misleading claims and treatment guidelines were not brought to light until the USA was in the midst of an opioid epidemic. Since 1999, there has been a steady increase in the number of opioids sold and opioid-related deaths (Manchikanti et al. 2012) (Fig. 1). Cumulative prescription dose of ≥ 700 morphine milligram equivalents, initial prescription for a 10- or 30-day supply, or a second prescription or refill were also associated with an increased incidence of chronic opioid use disorder at 1 year postoperative. [...]the incidence of long-term usage is approximately 15% in patients whose first episode of consumption is for > 8 days, and this rises as high as 30% for patients whose initial acute opioid use lasts 31 days or more (Shah et al. 2017). Loftus et al. found that ketamine reduced opioid consumption in the postoperative period 0 to 48 h (Loftus et al. 2010). [...]these investigators found that opioid-dependent patients treated with ketamine had reduced pain up to 6 weeks after surgery compared to controls (Loftus et al. 2010). [...]it has been suggested that regional anesthesia/analgesia procedures be offered to opioid-tolerant patients whenever feasible (Mitra and Sinatra 2004).