Opioids in the Perioperative Setting: Should We Be Worried?

The opioid epidemic is one of the only public health problems that continues to worsen throughout the world. While much of the focus has been placed on primary care and chronic pain prescribing, most people receive their first opioid exposure from an acute care episode, such as surgery. While opioids remain an important part of anesthesia and postoperative care, physicians have prescribed opioids after surgery far in excess of patient needs due to a lack of guidelines on optimal analgesia, follow-up and failure to recognize the potential for morbidity. Studies both in the US and Europe have shown that becoming a new chronic opioid user is the most common complication after elective surgery and yet a complication that surgeons have not previously discussed with their patients. In this workshop, we will discuss how opioid prescribing for surgery and other acute care directly contributes to short- and long-term morbidity. We will further discuss the importance of balancing opioid use perioperatively to treat post-operative pain and the potential for acute and chronic side effects. Lastly, we will explore the neuroscience for addiction and response to opioids using data from cutting edge neuroimaging techniques, to discuss future areas for improvement.