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An Evidence-Based Approach to the Prescription Opioid Epidemic in Orthopedic Surgery

Soffin, Ellen M. MD, PhD; Waldman, Seth A. MD; Stack, Roberta J. MS; Liguori, Gregory A. MD

doi: 10.1213/ANE.0000000000002433
Chronic Pain Medicine: Special Article

Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level. The main components of our program include (1) guidelines for managing patients who are opioid tolerant and/or have a substance abuse disorder; (2) education programs for patients, emphasizing the role of opioids in recovery after elective orthopedic surgery; (3) education programs for prescribers of controlled substances, including clinical and regulatory aspects; (4) the development of surgery-specific prescribing recommendations for opioid-naive patients; and (5) mechanisms to modify prescribing habits to limit unnecessary prescribing of controlled substances.

From the Department of Anesthesiology, Hospital for Special Surgery, New York, New York.

Accepted for publication July 24, 2017.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address for correspondence: Ellen M. Soffin, MD, PhD, Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. Address e-mail to soffine@hss.edu.

© 2017 International Anesthesia Research Society
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