American Society of Regional Anesthesia and Pain Medicine August 2016 - 6

Fighting the Opioid Epidemic in Our Community
OPIOID EPIDEMIC
Opioid use and abuse in the United States has received
considerable attention recently. Despite constituting only 4.4%
of the world's population, the United States consumes 80%
of the world's opioids. In 2012, there were 259 million opioid
prescriptions, which is enough for one bottle of opioids for every
adult in the United States. It is believed that 78 Americans die
every day from opioid-related overdoses.1 Although opioids are
commonly prescribed for acute and chronic pain, there are no
data to suggest that opioids are efficacious in the long-term
management of chronic pain.2 Instead, the morbidity and mortality
of chronic opioid use appear to far outweigh any of the potential
benefits.
Concurrent with the rise in opioid use and abuse, heroin abuse
has increased dramatically. The low cost of heroin compared to
prescription opioids has, in part, driven this change. In the last
decade, adolescent and adult abuse of heroin has increased by
63% and heroin-related deaths have increased by almost 300%.3
It is estimated that almost 75% of the new heroin users begin by
abusing prescription opioids, unlike heroin use from decades past
in which abusers began with heroin.
POSTOPERATIVE OPIOID
PRESCRIBING
Recently, the Centers for
Disease Control and Prevention
(CDC) released guidelines for
the prescribing of opioids for
chronic pain 4 that directly
relate to the practice of
the chronic pain physicians in the ASRA community. Whereas
the new CDC guideline discusses the safe and appropriate
prescribing of opioids for long-term management of chronic
pain, 3 there is little of the guideline devoted to postoperative
opioid prescribing. This obvious gap is in part due to the fact that
there are essentially no data to inform appropriate postoperative
opioid prescribing.

Chad M. Brummett, MD
Associate Chair, Faculty Affairs
Director, Clinical Anesthesia
Research
Director, Pain Research

Kristin Bennett
Administrative Assistant Senior

Department of Anesthesiology
Division of Pain Medicine
University of Michigan Medical School
Ann Arbor, MI
Section Editor: Andrea Nicol, MD

the preoperative education
and the prescriptions are
often nebulous (eg, "1-2
tablets every 4-6 hours
as needed for pain"). The
expected duration of use is
seldom discussed. Therefore,
patients are left to determine
when and for how long to take opioids, and their decisions
are often shaped by personal experience or that of a friend or
family member. If the entire prescription is not needed, patients
find themselves with a bottle of leftover pills. Few pharmacies
will accept leftover controlled substances, and flushing opioids
can have a detrimental environmental effect. Leftover opioids
are frequently stored unsecured in medicine cabinets and are
therefore accessible to adolescents and teens for future misuse
and abuse.8

"Despite constituting only 4.4% of the
world's population, the United States
consumes 80% of the world's opioids."

Opioids remain the primary treatment for acute postsurgical
pain. Recent guidelines have encouraged the use of nonopioid
analgesics and regional anesthesia where possible,5 but opioids
are still the primary analgesic provided after discharge from
surgery centers or hospitals. Recent studies demonstrate a
wide variance in postoperative prescribing patterns and note
that opioids are commonly prescribed for minor surgeries and
dentistry.6,7 As there are no normative data to inform appropriate
postoperative opioid prescribing, it is believed that prescription
practices are largely driven by convenience. The goal of physicians
is to ensure that patients have more than enough opioids to treat
their postoperative pain without requiring additional visits or calls
to the clinic or emergency department visits. In most centers,
however, postoperative pain management is not a formal part of

62

TEEN AND ADOLESCENT OPIOID ABUSE
As opioid use has increased in the United States, so has the
prevalence of opioid abuse in teens and adolescents. Prescription
medicines are now the most commonly abused drugs by 12 and
13 year olds, and an estimated 90% of addictions start in the
teenage years.9 Although some teens misuse or abuse medications
previously prescribed for injuries or surgeries, most teen abusers
obtain the medications from a friend or family member. Many teens
believe that opioids are safer than other drugs of abuse because
they are prescribed by a physician. Sadly, many teens and young
adults turn to heroin when they lose access to opioids or when
opioids become too expensive.10

American Society of Regional Anesthesia and Pain Medicine
2016



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American Society of Regional Anesthesia and Pain Medicine August 2016 - 2
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