How Anesthesiologists Are Fighting the Opioid Crisis

Opioid health risk and medical crisis with a prescription painkiller addiction epidemic represented by a group of people running away from a dangerous falling bridge of pills as a medicine addict problem.
Opioid health risk and medical crisis with a prescription painkiller addiction epidemic represented by a group of people running away from a dangerous falling bridge of pills as a medicine addict problem.

It?s no secret that the opioid crisis plaguing America is more dire than ever. Dramatic increases in both the misuse of prescription opioids and the use of illegal opioids [1][2] have yielded an addiction epidemic, hundreds of thousands of deaths and billions of dollars in healthcare costs. Today, it?s estimated that more than 130 Americans die each day from overdosing on some kind of opioid. [3]

While all of us in the medical profession?from healthcare practitioners to researchers to device manufacturers?aim to improve the health and better the lives of patients, some fields deal more heavily in the management and relief of pain than others; anesthesiology is one of these fields.

Pain management

Many patients?and a surprising number of healthcare practitioners?are under the impression that anesthesiologists merely help people sleep through medical procedures. While providing general anesthesia during operations is an important part of our work, in reality, our expertise is pain management across a wide range of medical specialties, including cardiology, obstetrics, emergency care, pediatrics, and others. We deal with pain management before, during and after surgery, and we help manage pain totally unrelated to surgery, like chronic neck and back pain.

As healthcare professionals whose primary objective is to minimize pain, we collectively face a difficult quandary: How can we provide effective relief to our patients while simultaneously combatting the mounting opioid crisis?

First, it?s important to understand the complex and evolving nature of the opioid crisis. There is no single root cause?the current conditions are the result of a number of interrelated factors slowly building over time, including: [4]

  • The over-prescription of opioids for pain management on the part of doctors;
  • General misinformation about the potential addictiveness of opioids;
  • Subjective, patient-reported pain control becoming the primary success indicator for hospitals, doctors and health systems;
  • A skewed and complex reimbursement system;
  • The availability of illegal, unregulated opioids.

Not surprisingly, there is no silver bullet for such a complicated state of affairs, and recent attempts to reduce opioid use have illustrated this problem perfectly.

Unforeseen consequences

For example, restricting the prescription of opioids was recently used as a method for cutting opioid-related overdoses. But, as the number of opioid prescriptions decreased (quite significantly, in fact), an unforeseen consequence quickly became apparent: the increased use of unregulated, illegal opioids like heroin [5]. With fewer prescription opioids available, heroin became an attractive alternative, as it was less expensive and easier to access. Another unintended consequence of prescription opioid cutback: Patients living with acute or chronic pain were not getting the treatment they needed.

In a similar vein, legislation was recently introduced to limit opioid prescriptions for acute pain?for example, the pain that occurs after a surgery?to just seven days. Though well-intentioned and careful to focus on acute rather than chronic pain, the legislation will, in practice, pose a problem for people who require the powerful pain relief of opioids to function?of which there are many.

According to the National Institutes of Health, about 25.3 million adults reported experiencing pain every day for 3 months, and nearly 40 million adults report severe levels of pain. For many of these people, opioids are critical to their ability to function on a daily basis.

Helping patients

As healthcare practitioners, we must commit to helping our patients manage chronic or acute pain in a way that is both effective and responsible. This will sometimes require the careful and mindful use of opioids, but can (and should) include other methods of pain relief, including individual and regional nerve blocks, epidurals, and steroid injections.

These other methods can be incredibly effective for patients?and without the uncomfortable side effects or potentially lethal consequences of opioids. In fact, patients who receive regional nerve blocks for surgery are often completely pain-free for 24-72 hours after surgery, and by the time the nerve block wears off, they are able to find pain relief with over-the-counter medications like Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs) and no longer need or want opioids.

Of course, for patients suffering from severe chronic pain, sometimes it?s necessary to prescribe opioids if other methods do not provide sufficient relief and opioids are demonstrated to dramatically improve a patient?s quality of life.

As more potential solutions and opioid alternatives are introduced, we, as anesthesiologists, are committed to working with other healthcare providers, insurers, drug companies, and governmental regulatory bodies to ensure that patients come first?and that opioids are used responsibly and conscientiously. 

References

[1] Cicero TJ, Ellis MS. The prescription opioid epidemic: a review of qualitative studies on the progression from initial use to abuse. Dialogues Clin Neurosci. 2017;19(3):259?269. [Article]

[2] Jiang R, Lee I, Lee TA, Pickard AS (2017) The societal cost of heroin use disorder in the United States. PLOS ONE 12(5): e0177323. [Article]

[3] DC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov

[4] How Good Intentions Contributed to Bad Outcomes: The Opioid Crisis. Teresa A. Rummans MD, Caroline Burton MDD, Nancy L. Dawson MD. May Clin Proc. March 2018: 93 (3): 344?350. [Article]

[5] Schuchat A, Houry D, Guy GP. New Data on Opioid Use and Prescribing in the United States. JAMA.2017;318(5):425?426. doi:10.1001/jama.2017.8913 [Article]

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Lynnus Peng, MD, is a practicing anesthesiologist with Allied Anesthesia in Orange County, California. Peng is doubled boarded in Anesthesiology and Emergency Medicine. He attended medical school at USC and did his residency at Johns Hopkins Hospital and UC Irvine Medical Center. He specializes in general and cardiac anesthesiology, is additionally an Associate Clinical Professor at UC Irvine and an active member of the Orange County Medical Association. Allied Anesthesia, the organization is a group of highly qualified anesthesiologists working at several Southern California hospitals, surgical centers and healthcare facilities. Allied physicians combine world class medical expertise with unmatched levels of patient care. The organization began as a group of loosely associated Orange County anesthesiologists. Today, the group is made up of over 100 anesthesiologists who have passed through one of the most rigorous vetting processes in the country, designed to filter out all but the top 1% of anesthesiologists. Allied Anesthesia is carefully structured and professionally managed and has a proven track record of providing truly exceptional adult and pediatric anesthesia services to the residents of Southern California. The organization is a member of the California Society of Anesthesiologists, the American Society of Anesthesiologists and the Healthcare Financial Management Organization.