oid prescribing rates in 2023 will be double what they were in 1995,
well before the CDC in 2001 declared pain as the fifth vital sign, a tip-
ping point that many experts believe caused healthcare providers to
overprescribe opioids to prevent patients from feeling even a hint of
discomfort following surgery.
Much of the effort aimed at solving the opioid crisis has focused on
limiting the prescribing of extended-release opioids to treat chronic
pain. But experts realize that chronic pain patients on long-term opi-
oids often began with a prescription for an injury or surgery, and
never stopped taking them.
"If we want fewer Americans to become addicted to opioids, we
need much more cautious prescribing for acute pain," says Dr.
Kolodny. "That's where surgeons come into play."
He says opioid prescribing has been trending in the right direction
since peaking in 2012, but also concedes there's plenty of work left to
do because physicians in no other country come close to using opi-
oids as aggressively as U.S. physicians do.
"We must treat pain more judiciously, set patients up with multi-
modal analgesics and practice better opioid stewardship," says Dr.
Manning.
Patients who take opioids as directed aren't contributing to the epi-
demic. It's the unused medication left in the medicine cabinet that
winds up in the hands of a drug-seeker. Virtually all states have passed
laws to limit initial post-op opioid prescriptions to 5 to 7 days and
require physicians to reassess patients before they write for a refill.
That's a positive development. So is the Opioid Prescribing
Engagement Network (OPEN) in Ann Arbor, Mich., a collaboration of
healthcare providers, health systems and insurers that's at the fore-
front of efforts to prevent chronic opioid use by limiting the number
of pills prescribed to individual patients and standardizing amounts
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