The prescription opioid epidemic: a call to action for our profession.

Abstract

There is no question that too many people die from the use and abuse of opioids. The article by Alam and Juurlink in this issue of the Journal provides an overview of the issue of the prescription opioid epidemic and contains several useful messages for anesthesiologists which I summarize in this editorial. In some way, however, the most important message for our profession is in the conclusion—i.e., anesthesiologists have a leadership role to play in the treatment of chronic pain. Understanding the limitations and value of opioids, as with all drugs, is crucial. There is an opportunity here for anesthesiologists to provide direction and to enhance knowledge, and there are several mechanisms through which to do so. Problem: Far too many people die from inappropriate (and sometimes appropriate) use of opioids. We don’t always use opioids according to the best evidence available or screen patients for risk of opioid abuse and manage their condition appropriately. That being said, there are potential solutions. As a profession, we are leaders in the practice of safety with an enviable improvement in anesthesia outcomes over the past 50 years. We have accomplished this by understanding our business through conducting systematic research, enhancing technical and pharmacological capabilities, and to a large extent, increasing our personal vigilance during anesthetic care. The same principles should apply to our practice vis-a-vis prescription opioids. Although Alam and Juurlink dismiss a national opioid guideline as ‘‘often not followed’’, the necessary information to support rational and appropriate use of opioids is well described in that guideline. In fact, the Annals of Internal Medicine reported that the ‘‘Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain’’ is one of two guidelines that are highly rated according to the AGREE system of rating guideline development and would be used ‘‘without modification’’ by more than 50% of the guideline reviewers. Using and teaching others to use this guideline could well lead to significant improvement in care. There is a national strategy to address prescription drug abuse. It is not only opioids that are problematic— stimulants and sedatives are also an issue—but in any event, the problem of opioid abuse is significant. The strategy entitled ‘‘First Do No Harm: Responding to Canada’s Prescription Drug Crisis’’ was announced by the Canadian Centre on Substance Abuse in 2014. The strategy was developed and endorsed by over 30 organizations across the country, including the Canadian Pain Society, opinion leaders (such as Dr. Irfan Dhalla), public health, law enforcement, First Nations, dentistry, pharmacy, the Institute for Safe Medication Practices, patients, relatives of patients, victims of drug abuse or drug-related adverse events, the research-based pharmaceutical industry, and others. Out of this strategy came 55 specific initiatives on which to take action. Such initiatives include significantly enhancing the education of healthcare professionals on the topics of both pain and addiction and their management. A lack of knowledge and access to care in these areas has been identified as one of the root causes of widespread prescribing of opioids for pain in the absence of substantial evidence to support this practice. Problem: Pain and addiction are two poorly understood problems for which optimal treatment is often not available There are potential solutions to the above problem. We need more knowledge about pain assessment and N. Buckley, MD (&) Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, Canada