Overdose-related Deaths Research Articles

Combating The Opioid Crisis And Its National Security Threat Through CReDO: A Multidisciplinary Solution With Disaster Medicine Implications.

For the first time in history, the United States surpassed 100,000 overdose-related deaths in a 12-month period, driven by synthetic opioids such as fentanyl. Also for the first time, potential chemical weapons are readily available on the streets and the dark web. Opioids represent a rare trifecta, used for licit pain management, as an illicit drug of abuse, and with potential use as a weapon of terror. Community-based Response to Drug Overdose (CReDO) is an initiative to unite agencies, disciplines, government and private partners in one coordinated opioid emergencies response plan under nationwide standards, and can be integrated into the Disaster Medicine discipline due to the risk of mass casualty incidents involving fentanyl or its derivatives. Attention to the opioid crisis through CReDO will save lives by promoting information sharing between disciplines, shortened response time to overdose clusters, community collaboration to identify criminal distribution networks, and holistic approaches to addiction.

Perioperative opioid management for minimally invasive hysterectomy.

Given the high volume of hysterectomies performed, the contribution of gynecologists to the opioid crisis is potentially significant. Following a hysterectomy, most patients are over-prescribed opioids, are vulnerable to developing new persistent opioid use, and can be the source of misuse, diversion, or accidental exposure. People who misuse opioids are at risk of an overdose related death, which is now one of the leading causes of death in the United States and is rising in other countries. It is the physician's responsibility to reduce opioid use by making impactful practice changes, such as 1) using pre-emptive opioid sparing strategies, 2) optimizing multimodal nonopioid pain management, 3) restricting postoperative opioid prescribing, and 4) educating patients on proper disposal of unused opioids. These changes can be implemented with an enhanced recovery after surgery protocol, shared decision-making, and patient education strategies related to opioids.

Confronting the devastating ‘Twindemic’: Drug overdose deaths and the COVID-19

Summary: The last 25 years have seen a dramatic increase in drug overdose related deaths in both the industrialized and developing countries. Hundreds of thousands of people die every year. This human tragedy has recently been complicated by the COVID-19 epidemic, sidelining the minimal effort that was being implemented. As a global community, the governments, medical institutions, NGOs and the general public need to focus on this devastating human tragedy before more lives are lost senselessly, and unnecessarily.Increased public awareness about new approaches to manage the already afflicted ones including targeted, minimally invasive procedures is required. In addition, the focus needs to be on aggressive research and development of innovative and safer medications and newer modalities for those suffering from chronic pain.This paper offers a perspective, context and a vision for future.
 Key words: Opioid epidemic; Drug overdose; Drug-related deaths; Chronic pain; COVID-19; Safer pain medications
 Citation: Purvez A. Confronting the devastating ‘twindemic’; drug overdose deaths and the COVID-19. Anaesth. pain intensive care 2022;26(6):734−735;
 DOI: 10.35975/apic.v26i6.2064Received: October 26, 2022; Revised: October 29, 2022; Accepted: October 29, 2022

Spatial-temporal trends in the risk of illicit drug toxicity death in British Columbia

BackgroundIllicit drug poisoning (overdose) continues to be an important public health problem with overdose-related deaths currently recorded at an unprecedented level. Understanding the geographic variations in fatal overdose mortality is necessary to avoid disproportionate risk resulting from service access inequity.MethodsWe estimated the odds of fatal overdose per event from all cases captured by the overdose surveillance system in British Columbia (2015 - 2018), using both conventional logistic regression and Generalized Additive Models (GAM). The results of GAM were mapped to identify spatial-temporal trends in the risk of fatal overdose.ResultsWe found that the odds of fatal overdose were about 30% higher in rural areas than in large urban centers, with some regions reporting odds 50% higher than others. Temporal variations in fatal overdose revealed an increasing trend over the entire province. However, the increase occurred earlier and faster in the Interior and Northern regions.ConclusionRural areas were disproportionately affected by fatal overdose; lack of access to harm reduction services may partly explain the elevated risk in these areas.

An Epidemic within a Pandemic: An 8-Year-Old Boy with Xylazine-Complicating Fentanyl Poisoning, and Drug Detection Challenges.

The Centers for Disease Control and Prevention (CDC) has reported an increase in nonmedical drug use during a short time period in combination with declining mental health and increasing suicidal ideation during the SARS-CoV2 pandemic (1). In 2014, >47 000 people in the United States died as a result of a drug overdose (2). This figure is double the number of fatal drug overdoses reported in 2000 (2) and, as of the final quarter of 2021, rose to >100 000 drug overdose related deaths (3). Furthermore, prior to the SARS-CoV2 outbreak, in 2019, 1150 people died from drug overdoses in Philadelphia, with 80% of overdose deaths involving opioids/opiates (2). A recent study by Korn et al., identified xylazine in 78% of inpatients at Thomas Jefferson University Hospital who had screened positive for fentanyl (4). These figures have likely risen between 2020 and 2022 given the findings by the CDC, although the actual figures are difficult to determine given that testing during the SARS-CoV-2 pandemic significantly declined.

Evaluation of Naloxone Co-Prescribing Rates for Older Adults Receiving Opioids via a Meds-to-Beds Program

Over 10,000 older adults died from opioid overdose in 2019. Naloxone is an underutilized antidote that could prevent many opioid overdose-related deaths. There is a paucity of literature evaluating naloxone prescribing through meds-to-beds programs and in older adults. This single-center, retrospective, observational cohort study aimed to assess prescribing patterns of naloxone in patients 65 years and older who were prescribed opioids via a meds-to-beds program between December 2020 and November 2021. All patients 65 years and older dispensed an opioid via meds-to-beds were included. Patients receiving hospice or comfort care or those with unavailable records were excluded. The primary outcome was to assess the frequency of naloxone co-prescribing with opioid prescriptions via meds-to-beds. The 144 patients included were primarily females with a median age of 69 years old and opioid prescriptions for 45 morphine milligram equivalents daily. Two patients were prescribed naloxone (1.4%), one of whom was ultimately dispensed naloxone (0.7%). Of the 65 prescribers included in our study, the incidence of naloxone co-prescribing (2/65, 3.1%) was no different from a previously-reported rate among prescribers (3/179, 1.7%), p = 0.61. Naloxone co-prescribing for older adults receiving opioid prescriptions through a meds-to-beds program was low and opportunities for program enhancement exist.

Hippocampal and amygdalar increased BDNF expression in the extinction of opioid-induced place preference

The opioid crisis was exacerbated during the COVID-19 pandemic in the United States with alarming statistics about overdose-related deaths (Ahmad et al., 2022). Current treatment options, such as medication assisted treatments, have been unable to prevent relapse in many patients, whereas cue-based exposure therapy have had mixed results in human trials. To improve patient outcomes, it is imperative to develop animal models of addiction to understand molecular mechanisms and identify potential therapeutic targets. We previously found increased brain derived neurotrophic factor (bdnf) transcript in the ventral striatum/nucleus accumbens (VS/NAc) of rats that extinguished morphine-induced place preference. Here, we expand our study to determine whether BDNF protein expression was modulated in mesolimbic brain regions of the reward system in animals exposed to extinction training. Drug conditioning and extinction sessions were followed by Western blots for BDNF in the hippocampus (HPC), amygdala (AMY) and VS/NAc. Rears, as a measure of withdrawal-induced anxiety were also measured to determine their impact on extinction. Results showed that animals who received extinction training and successfully extinguished morphine CPP significantly increased BDNF in the HPC when compared to animals deprived of extinction training (sham-extinction). This increase was not significant in animals who failed to extinguish (extinction-resistant). In AMY, all extinction-trained animals showed increased BDNF, regardless of behavior phenotype. No BDNF modulation was observed in the VS/NAc. Finally, extinction-trained animals showed no difference in rears regardless of extinction outcome, suggesting that anxiety elicited by drug withdrawal did not significantly impact extinction of morphine CPP. Our results suggest that BDNF expression in brain regions of the mesolimbic reward system could play a key role in extinction of opioid-induced maladaptive behaviors and represents a potential therapeutic target for future combined pharmacological and extinction-based therapies.

Implementation of a multidisciplinary inpatient opioid overdose education and naloxone distribution program at a large academic medical center.

Opioid overdose-related deaths continue to rise. Despite public health efforts, there is still variability in obtainment of naloxone, a lifesaving antidote. We share our experience in the implementation of a novel opioid overdose education and naloxone distribution (OEND) program at a large academic medical center. Collaborative efforts made by pharmacists, pharmacy students, physicians, nurses, and recovery coaches were employed in the design of the program. The service was available Monday through Friday, 9 am to 6 pm, and primarily carried out by pharmacy students on a rotating basis. Services offered included bedside delivery of naloxone and education prior to the day of discharge. In preparation for their role, the pharmacy students were required to complete a series of trainings and competency assessments. A total of 40 patients were included in the program evaluation. Of the completed consults 96.7% (n = 30) of patients received both counseling and naloxone delivery. Eighty percent of patients had a history of nonfatal opioid overdose, but only 37.5% had naloxone listed as a home medication. OEND services were provided to 66% of individuals with patient-directed discharges. Implementation of an inpatient OEND program by mobilizing trained student pharmacists is feasible and expands naloxone access to patients during transitions of care. A similar model could be considered in the future for the delivery of harm reduction supplies to this patient population.

Early-Onset Cardiovascular Disease From Cocaine, Amphetamines, Alcohol, and Marijuana.

Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine, and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early-onset CVD. While this remains a global phenomenon, the epicentre of substance abuse is rooted in North America, where it has been exacerbated by the response to the COVID-19 pandemic. For the first time in history, the United States crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death, and early mortality.

A student centered interprofessional awareness program to increase knowledge and improve attitudes about substance use disorder

Substance Use Disorders (SUDs) constitute a national public health crisis resulting in nearly 91,000 overdose related deaths annually. Negative attitudes and stigma within the general population, as well as healthcare professionals, towards individuals with SUDs present a barrier to identification and treatment. SUD related training programs exert a positive influence on the attitudes of health care professionals. To evaluate the impact of a SUDs training seminar on the attitudes and perceptions of occupational therapy, pharmacy, and physician assistant students towards individuals with SUDs, as well as the perceived value of interprofessional education and collaboration. Two standardized assessments were utilized to determine the course impact on knowledge and attitudes regarding interprofessional teams and stigma related to SUDs after completion of a 2-day interprofessional seminar. Analysis of the survey responses revealed statistically significant changes in all factors related to participants’ values and understanding of Interprofessional Education Collaborative (IPEC) compentencies as well as many of the factors regarding attitudes towards SUDs and their treatment. The activities incorporated in the two-day seminar were effective in exerting statistically significant changes in student knowledge of interprofessional teams and attitudes towards SUDs.

State‐dependent breathing emerges from interactions between repeated opioid use (ROU) and context

ROU is arguably the single‐most influential factor driving respiratory‐related morbidities, overdose, and overdose‐related deaths in the ongoing opioid epidemic. When ROU is paired with the same environmental context (i.e., the drug‐paired context), it can produce pharmacodynamic tolerance to overdose‐related deaths. However, it is not clear if this context‐dependent tolerance impacts opioid induced respiratory depression (OIRD). This ongoing work examines how context pairing with ROU impacts breathing and OIRD. We developed a mouse model of ROU where five days of fentanyl administration (0.7 mg/kg) is paired with the same context. On subsequent testing days, OIRD in the fentanyl‐paired context (FP) was compared to OIRD in a novel environment. In the majority of mice (n=7 of 11), OIRD in the FP was smaller when compared to OIRD in the novel environment. Additionally, unsupervised machine learning of breathing metrics revealed that breathing patterns following ROU is distinct in FP as compared to that in the novel environment. These results indicate that behavior related to ROU impacts the consequence of opioids on breathing and produces predictable forms of state‐dependent breathing. Our findings may be leveraged to better predict and/or mitigate the occurrence of overdose‐related deaths associated with ROU.

A Model of Repeated Opioid Use Producing Tolerance to Opioid Induced Respiratory Depression

Repeated opioid users, such as those who suffer from opioid use disorder, are among the most vulnerable to overdose, overdose‐related death, and opioid‑related morbidities in breathing in the ongoing epidemic. Despite the significant progress made in defining the cellular and circuit basis by which opioid induced respiratory depression (OIRD) occurs, very little is known about the impact that repeated opioid use (ROU) has on the control of breathing. This ongoing work aims to define how ROU impacts the OIRD. We developed a mouse model of ROU that involved six consecutive days of fentanyl (0.7mg/kg via i.p. injection) administration. Breathing was measured via unrestrained whole‐body plethysmography prior to and immediately after fentanyl administration on Day 1 and Day 6. Prior to fentanyl administration, tidal volume (TV), respiratory rate (RR) and minute ventilation (Vmin) were similar on Day 1 and Day 6 (n= 7 mice). Peak depression of TV during fentanyl was similar on Day 1 and Day 6 (n=7, P=0.28); whereas, peak depression of RR (Day 1: 145.5±19.66­BPM vs. Day 6: 172.0 ± 18.89,P=0.005) and Vmin (Day 1: 142.0±30.23­microL•min‐1•g‐1 vs. Day 6: 210.1±21.96­microL•min‐1•g‐1, P=0.04) during fentanyl was greater on Day 1 (n= 6 of 7). Moreover, the change in body temperature during OIRD was not different between Day 1 and Day 6 (Day 1: 0.04±0.021oC vs. Day 6: 0.64 ± 0.021oC, P=0.62). Together these data suggest that tolerance to OIRD emerges following six days of ROU and does not involve significant changes in body temperature. The data from this ongoing study provides foundational knowledge to the impact of ROU on breathing and introduces a novel model of ROU that leads to tolerance to OIRD.

Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone.

Hydrocodone and oxycodone are prescribed commonly to treat pain. However, differences in risk of opioid-related adverse outcomes after an initial prescription are unknown. This study aims to determine the risk of opioid-related adverse events, defined as either chronic use or opioid overdose, following a first prescription of hydrocodone or oxycodone to opioid naïve patients. A retrospective analysis of multiple linked public health datasets in the state of Oregon. Adult patients ages 18 and older who a) received an initial prescription for oxycodone or hydrocodone between 2015-2017 and b) had no opioid prescriptions or opioid-related hospitalizations or emergency department visits in the year preceding the prescription were followed through the end of 2018. First-year chronic opioid use was defined as ≥6 opioid prescriptions (including index) and average ≤30 days uncovered between prescriptions. Fatal or non-fatal opioid overdose was indicated from insurance claims, hospital discharge data or vital records. After index prescription, 2.8% (n = 14,458) of individuals developed chronic use and 0.3% (n = 1,480) experienced overdose. After adjustment for patient and index prescription characteristics, patients receiving oxycodone had lower odds of developing chronic use relative to patients receiving hydrocodone (adjusted odds ratio = 0.95, 95% confidence interval (CI) 0.91-1.00) but a higher risk of overdose (adjusted hazard ratio (aHR) = 1.65, 95% CI 1.45-1.87). Oxycodone monotherapy appears to greatly increase the hazard of opioid overdose (aHR 2.18, 95% CI 1.86-2.57) compared with hydrocodone with acetaminophen. Oxycodone combined with acetaminophen also shows a significant increase (aHR 1.26, 95% CI 1.06-1.50), but not to the same extent. Among previously opioid-naïve patients, the risk of developing chronic use was slightly higher with hydrocodone, whereas the risk of overdose was higher after oxycodone, in combination with acetaminophen or monotherapy. With a goal of reducing overdose-related deaths, hydrocodone may be the favorable agent.

\u201cThe DEA would come in and destroy you\u201d: a qualitative study of fear and unintended consequences among opioid prescribers in WV

BackgroundWest Virginia has one of the highest rates of opioid overdose related deaths and is known as the epicenter of the opioid crisis in the United States. In an effort to reduce opioid-related harms, SB 273 was signed in 2018, and aimed to restrict opioid prescribing in West Virginia. SB 273 was enacted during a time when physician arrests and convictions had been increasing for years and were becoming more prevalent and more publicized. This study aims to better understand the impact of the legislation on patients and providers.MethodsTwenty semi-structured interviews were conducted with opioid-prescribing primary care physicians and specialists practicing throughout West Virginia.ResultsFour themes emerged, 1. Fear of disciplinary action, 2. Exacerbation of opioid prescribing fear due to restrictive legislation, 3. Care shifts and treatment gaps, and 4. Conversion to illicit substances. The clinicians recognized the harms of inappropriate prescribing and how this could affect their patients. Decreases in opioid prescribing were already occurring prior to the law implementation. Disciplinary actions against opioid prescribers resulted in prescriber fear, which was then exacerbated by SB 273 and contributed to shifts in care that led to forced tapering and opioid under-prescribing. Providers felt that taking on patients who legitimately required opioids could jeopardize their career.ConclusionA holistic and patient-centered approach should be taken by legislative and disciplinary bodies to ensure patients are not abandoned when disciplinary actions are taken against prescribers or new legislation is passed.

An Exploration of Narcan as a Harm Reduction Strategy and User's Attitudes toward Law Enforcement Involvement in Overdose Cases.

The street homeless, those who spend their nights either in shelters or unofficial camps, whether in tents on a street or in society’s hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep. Of further concern is how official actions can worsen these situations, through day-to-day activities or planned intervention strategies. In this paper we explore how a planned intervention may be negatively perceived—even as a form of “structural violence”—and may prevent Narcan (naloxone) use to stop an overdose related death in the Skid Row of Los Angeles. Data for this study consisted of a combination of Spatial Video Geonarratives (SVGs) and 325 incident reports from the Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC) between November 2014 and December 2015. Chi-square and simple logistic regression models were used to examine the association between fear-of-arrest and other covariates of interest. Mapping results are presented with different sets of shapefiles created for (1) all Narcan uses, (2) all homeless, (3) all homeless with a worry about being arrested, (4) all Narcan uses where an ambulance attended, (5) and the same as 4 but also with police attendance. In the multivariable model, the estimated adjusted odds of fear-of-arrest is over three times higher among Narcan users ages 30–39 when compared to users under the age of 30. Analyzing the association of calling 9-1-1 on Narcan user demographics, socio-contextual characteristics, and overdose victim demographics, the crude estimated probability of calling 9-1-1 for Narcan users aged 50 and older is nearly three times higher when compared to Narcan users aged 19–29. Conclusion: Results suggest that the fear-of-arrest and calling 9-1-1 during an overdose is still a concern among Narcan users despite protective legislation and access to harm reduction resources.

When Management of Cancer-Related Pain Is Complicated by Coexisting Opioid Use Disorder: A Case Review.

Patients with cancer are living longer, and many experience pain secondary to tumor invasion or as a consequence of cancer-directed therapies. Opioid use disorders and associated morbidity and mortality have increased with dramatic rise during the SARS-CoV-2 pandemic. National and international stakeholders have developed clinical practice guidelines in an effort to curb opioid misuse and overdose-related death. However, to ensure that patients with cancer do not experience barriers to adequate pain management, most of these guidelines are not intended for patients with cancer-related pain or for those receiving palliative or hospice care. Oncology, palliative, and hospice care providers are increasingly tasked with the management of severe disease-related pain in the setting of coexisting opioid use disorder without research on the most effective risk and harm reduction strategies to guide care. Clinicians should be familiar with addiction medicine and chronic pain literature and be able to incorporate some of these best practices. This case study reviews the management of severe cancer-related pain in a patient with co-occurring opioid use disorder, utilizing many of the best practices in available clinical practice guidelines for the management of chronic non-cancer-related pain.

State naloxone co-prescribing laws show mixed effects on overdose mortality rates

Objective To examine the relative changes in opioid overdose mortality rates between states that have and have not adopted naloxone co-prescribing laws. Methods We performed a synthetic control analysis. National Vital Statistics data for the years 2012–2018 were analysed, and five states with naloxone co-prescribing laws were examined: Arizona, Florida, Rhode Island, Vermont, and Virginia. Opioid overdose-related deaths were identified through cause-of-death ICD-10 codes. Results Our pooled analysis for all opioid-related deaths showed no significant changes in opioid-related mortality rates in treated states, post naloxone co-prescribing law adoption (−0.05; 95% CI: −0.43, 0.33). Rates of other and unspecified narcotic-related mortality rates in Rhode Island were found to have decreased post-law adoption (−0.13; 95% CI: −0.25, −0.00). Conclusions These findings suggest that naloxone co-prescribing laws were not associated with changes to overall opioid overdose mortality rates, post-law adoption, during the study period. However, Rhode Island did see a decrease in other and unspecified narcotic-related mortality rates post-law adoption. This is perhaps due to the comprehensive nature of the state's law. As overall rates of naloxone co-prescribing remain low, interventions to enhance naloxone prescribing and distribution may be necessary for co-prescribing laws to impact opioid-related mortality rates.

The Public Health Approach to the Worsening Opioid Crisis in the United States Calls for Harm Reduction Strategies to Mitigate the Harm From Opioid Addiction and Overdose Deaths

The opioid crisis has devastated the U.S. more than any other country, and the epidemic is getting worse. While opioid prescriptions have decreased by more than 40% from its peak in 2010, unfortunately, opioid-related overdose deaths have not declined but continued to increase. With greater scrutiny on prescription opioids, many users switched to the cheaper and more readily available heroin that drove up heroin-related overdose deaths from 2010 to peak in 2016, being overtaken by the spike in synthetic opioid (mostly fentanyl)-related overdose deaths. The surge in fentanyl-related overdose deaths since 2013 is alarming as fentanyl is more potent and deadly. One thing is certain the opioid crisis is not improving but has become dire with the surge in fentanyl-related overdose deaths. Evidence-based strategies have to be implemented in the U.S. to control this epidemic before it destroys more lives. Other countries, including European countries and Canada, have invested more in harm reduction strategies than the U.S. even though they (especially Europe) do not face anywhere near the level of crisis as the U.S. In the long-run, upstream measures (tackling the social determinants of health) are more effective public health strategies to control the epidemic. In the meantime, however, harm reduction strategies have to be employed to mitigate the harm from addiction and overdose deaths.

Addressing fentanyl use disorder with fentanyl-assisted treatment

The opioid overdose crisis has evolved into one of the worst public health emergencies in North America, with mortality rates having skyrocketed since 2015. 1 Ahmad F Rossen L Sutton P Provisional drug overdose death counts. National Center for Health Statistics. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htmDate: 2021 Date accessed: September 12, 2021 Google Scholar , 2 British Columbia Coroners ServiceIllicit Drug Toxicity Deaths in BC. Jan 1, 2011–April 30, 2021. https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdfDate accessed: September 29, 2021 Google Scholar The current political and public health responses have not done much to change the trajectory of the crisis. Moreover, neither the free distribution of psychotropic substances in a non-therapeutic context (safe supply), nor the available opioid agonist treatments (OAT), which are largely based on buprenorphine as first-line medication, have helped slow down the accumulating death toll. 3 Krausz RM Wong JSH Westenberg JN Choi F Schütz CG Jang KL Canada's response to the dual public health crises: a cautionary tale. Can J Psychiatry. 2021; 66: 349-353 Crossref PubMed Scopus (2) Google Scholar A similar critical situation is also unfolding in two Baltic states, Lithuania and Latvia. 4 Krausz RM Westenberg JN Ziafat K The opioid overdose crisis as a global health challenge. Curr Opin Psychiatry. 2021; 34: 405-412 Crossref PubMed Scopus (13) Google Scholar This crisis is having a direct effect on life expectancy, and is challenging the field of psychiatry, which is failing in the treatment of substance use and concurrent disorders. 5 Ye X Sutherland J Henry B Tyndall M Kendall PRW At a glance – impact of drug overdose-related deaths on life expectancy at birth in British Columbia. Health Promot Chronic Dis Prev Can. 2018; 38: 248-251 Crossref PubMed Scopus (39) Google Scholar

Opioid Medication Use and Education Following Sports Medicine Procedures: An Evidence-to-Practice Review

According to the Centers for Disease Control (CDC), illicit and prescription drug overdoses are responsible for 128 deaths every day in the United States. In 2018, 70% of all overdose related deaths involved opioids. Efforts to minimize the opioid epidemic focus on community education, research, partnership, and healthcare support. Under the CDC guidelines, current practices include monitoring trends of drug use and drug related deaths, conducting research to recognize areas in need of improvement and to analyze effectiveness of current treatments, partner with community organizations and healthcare systems that deal firsthand with opioid users, and educate the public on drug use, misuse, and overdoses. People are commonly uneducated on the proper use and disposal of their prescription opioids. Consistent and appropriate communication among surgeons and their patients can decrease this risk associated with prescription drugs. The purpose of this evidence-to-practice review was to summarize a systematic review on the current data and findings related to postoperative opioid prescribing and consumption behaviors after a common sports medicine operation. The guiding systematic review explored several ways to reduce the risk of patients developing opioid dependence and abuse due to physicians overprescribing opioids. First, educating each patient about pain management during pre- and postoperative phases, how to store opioids safely, and how to dispose of opioids properly need to be created to help reduce the risk of the patient abusing opioids. Secondly, having the prescribing provider create an extensive history that reveals any red flags for opioid abuse for each patient. Thirdly, the prescribing provider should prescribe the lowest dose and shortest regimen to limit the number of opioids left over. These protocols may help slow the current opioid epidemic.