M
ore than 2 million Americans suffer from
opioid-use disorder — and that might be
a conservative estimate. This has led to a
dramatic increase in patients presenting for surgery
who are illicitly using opioids or in recovery from a
problematic pattern of opioid use. Don't fall into the
trap of treating these individuals like opioid naïve
patients. Improving pain management protocols for
patients with opioid use disorder will lead to vast
improvements in the care they receive, save lives
and protect the sobriety they have worked so hard
to rebuild.
Understand the risks
Surgery is an especially stressful time for
patients with opioid use disorder. They worry about
the success of the procedure and complications
from anesthesia like everyone else, but also face the
risk of relapse from exposure to opioids given dur-
ing or after surgery.
In addition, opioid use disorder causes changes
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to the nervous system that make providing anes-
thesia and managing pain particularly challenging.
The American Psychiatric Society lists some of the
symptoms of opioid use disorder as increased tol-
erance to opioids and sensitivity to pain.
Additionally, the standard treatment for opioid use
disorder includes medication-assisted therapy,
which includes buprenorphine/naloxone or nal-
trexone. These medications block the opioid
receptors and make using opioids to treat pain
even less effective.
It's clear opioids aren't effective at controlling
pain in patients with opioid use disorder. It's also
ethically unsupportable to expose them to the drug
of their addiction without first exhausting all other
efforts at controlling their pain.
Improve communication
Care of the patient with opioid use disorder
is still a subjective area that must be guided by the
best evidence of addictionology, pain management
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Caring for Patients With Opioid Use Disorder
Commit to the extra effort and attention needed to manage their post-pain.
Anesthesia Alert
Tom Baribeault, CRNA
BETTER OPTION A judicious use of regional blocks is one effective way to avoid using opioids for these high-risk patients.