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America’s Opioid Epidemic: Supply and Demand Considerations

Clark, David J. MD, PhD*; Schumacher, Mark A. MD, PhD

doi: 10.1213/ANE.0000000000002388
Chronic Pain Medicine: Special Article

America is in the midst of an opioid epidemic characterized by aggressive prescribing practices, highly prevalent opioid misuse, and rising rates of prescription and illicit opioid overdose-related deaths. Medical and lay public sentiment have become more cautious with respect to prescription opioid use in the past few years, but a comprehensive strategy to reduce our reliance on prescription opioids is lacking. Addressing this epidemic through reductions in unnecessary access to these drugs while implementing measures to reduce demand will be important components of any comprehensive solution. Key supply-side measures include avoiding overprescribing, reducing diversion, and discouraging misuse through changes in drug formulations. Important demand-side measures center around educating patients and clinicians regarding the pitfalls of opioid overuse and methods to avoid unnecessary exposure to these drugs. Anesthesiologists, by virtue of their expertise in the use of these drugs and their position in guiding opioid use around the time of surgery, have important roles to play in reducing patient exposure to opioids and providing education about appropriate use. Aside from the many immediate steps that can be taken, clinical and basic research directed at understanding the interaction between pain and opioid misuse is critical to identifying the optimal use of these powerful pain relievers in clinical practice.

From the *Department of Anesthesiology, Stanford University, Palo Alto, California; and UCSF Department of Anesthesia and Perioperative Care, Division of Pain Medicine, San Francisco, California.

Accepted for publication June 26, 2017.

Funding: J.D.C. is supported by Veteran’s Affairs Merit Review Grant 2I01BX000881 and M.A.S. from UCSF Department of Anesthesia Research Award.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to David J. Clark, MD, PhD, Department of Anesthesiology, Stanford University, 3801 Miranda Ave, Palo Alto, CA 94304. Address e-mail to

© 2017 International Anesthesia Research Society
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