dards to specific patients requires more investigation. "That's the next
step," says Dr. Hannon.
"The long-term goal is to create individualized opioid prescriptions
based on patient factors, the type of surgery they had, their risk for pro-
longed opioid use and whether they've had opioids for previous surger-
ies," he adds.
Dr. Hannon envisions scenarios where a doctor can, based on that
personal information and other factors such as the patient's pain
perception, be much more precise and about opioid prescriptions.
Dr. Brummett believes opioid-related patient prescreening and opi-
oid-sparing regimens like Enhanced Recovery After Surgery (ERAS)
aren't pervasive right now. "I don't think anyone is doing this really
well," he says. "Finding non-stigmatizing ways to screen patients effi-
ciently is not a simple thing to do."
He advises to watch for certain factors associated with new per-
sistent use of opioids: anxiety, depression, sleep disorders, chronic
pain conditions, history of abuse of alcohol and other substances,
and tobacco use. Another important factor: remote opioid use. "We
often know a person isn't using opioids, but we don't know if they've
used them previously for a prolonged period of time," he says. "If
they have, there's a better chance they will abuse opioids than
would an opioid-naïve patient.
Indeed, it's vital to delineate the patient's risk factors associated
with dependence. "The No. 1 predictor of post-operative opioid use is
pre-operative opioid use," says Dr. Hannon.
'A long way to go'
Researchers, physicians, professional societies and governmental agen-
cies are just several of the many parties looking to curb access to opi-
oids by standardizing prescriptions. The overprescribing problem touch-
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