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What Orthopaedic Surgeons Need to Know: The Basic Science Behind Opioids

Hagedorn, John C. II MD; Danilevich, Maxim MD; Gary, Joshua L. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: September 15, 2019 - Volume 27 - Issue 18 - p e831-e837
doi: 10.5435/JAAOS-D-18-00438
Review Article

On October 26, 2017, US president, Donald J. Trump, declared the opioid epidemic a national public health emergency. This declaration opened the door to government funding for programs geared toward studying and treating opioid addiction; however, part of the responsibility to slow the epidemic falls on physicians. Orthopaedic surgeons prescribed the third-highest number of narcotic prescriptions among all physician groups, and therefore, they have a major role to play in decreasing the use of opioids. Although restricting prescriptions is part of the solution, orthopaedic surgeries are often painful, and opioid medications, along with other multimodal nonopioid medications, allow patients to control pain and improve function, especially in the short term. Therefore, to successfully manage pain and opioid prescriptions, orthopaedic surgeons should know the basic science behind these powerful medications. Understanding the basic mechanism of action of opioid and nonopioid medication classes, knowing what oral morphine equivalent are, and knowing which nonopioid drugs can amplify or weaken the potency of opioids will help orthopaedic surgeons become more informed prescribers and leaders in helping control the opioid epidemic.

From the Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, TX (Dr. Hagedorn and Dr. Danilevich), and the Department of Orthopaedic Surgery, McGovern School of Medicine, University of Texas Health Science Center Houston, Houston, TX (Dr. Gary).

Dr. Hagedorn or an immediate family member is an employee of and has stock or stock options held in Abbott and serves as a board member, owner, officer, or committee member of Orthopaedic Trauma Association. Dr. Gray or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Smith & Nephew; has stock or stock options held in Summitt Medventures; has received research or institutional support from AO North America and Microbian; serves as a board member, owner, officer, or committee member of AO North America and Orthopaedic Trauma Association. Neither Dr. Danilevich nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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