have shown that depression and preoperative marijuana use are associated with postoperative opioid
misuse among adolescents.
20, 21 Preoperative screening
for these factors is recommended so that providers
can offer necessary resources to mitigate the risk of
Cancer patients experience pain at exceedingly
22 an estimated 25 percent of this pain is
secondary to treatment, including operative procedures.
23 Chronic opioid use in these patients can cause
decreased efficacy, which complicates control of acute,
22 It is vital that patients understand that
full disclosure of their baseline opioid use is critical
to safe, adequate postoperative pain management,
as well as the prevention of withdrawal symptoms.
This conversation should occur preoperatively and
involve a nonjudgmental approach to elicit honest
22 Guidance regarding perioperative
medication use should be provided, including instructions to take pain medication at home the morning of
surgery and information regarding the continued use
of the transdermal patch, if applicable.
It is important not only to educate patients about
pain medication use, but also about the anticipated
level of pain control, reassuring them that the ultimate
goal is to adequately control their acute, operative
pain rather than mitigate their existing symptoms.
However, in some circumstances, surgical treatment
may relieve preoperative pain, such as in cases of pain
due to compression.
23 Patients should, therefore, have
a clear understanding that their symptoms will be
reevaluated after postoperative healing to assess
whether their baseline opioid requirements have
changed. Throughout this process, it is important
not to lose sight of the ultimate goal—pain control.
Published research suggests that cancer patients over-
all have very low rates of opioid abuse; fear of misuse,
by either the patient or provider, should not preclude
Colorectal surgery: IBD
Opioid counseling in patients with IBD poses a unique
challenge for health care providers. Studies suggest
that these patients use preoperative opioids at high
rates and are at increased risk for misuse.
25 This risk
appears to be more significant for patients with Crohn’s
disease than ulcerative colitis.
26, 27 High rates of narcotic
usage for these patients are an independent predictor of increased readmissions; emergency department
visits; and high treatment charges, defined as more
than $30,000 in the year after the index admission.
Increased rates of abuse for patients with IBD also
TABLE 1. CHART TEMPLATE FOR EDUCATING PATIENTS ON OPIOID OPTIONS
Generic name Brand name
administration Common dose
Oxycodone/acetaminophen Percocet 5 mg oxycodone/ 325 mg acetaminophen
5 mg hydrocodone/
325 mg acetaminophen
Hydromorphone Dilaudid 2 mg
5 mg hydrocodone
Codeine/acetaminophen Tylenol #3
Arymo (extended release)
15 mg 12 hours
Methadone Methadose Dolophine 5 mg 8 hours
Oxycodone (extended release) OxyContin 10 mg 12 hours
No recommended dose
on route of
V102 No 8 BULLETIN American College of Surgeons