opioids, this situation contributes to illicit use. Nearly
55 percent of illicit opioid users reported obtaining the
medications from friends or family for free, 11. 4 percent
bought them from a friend or relative, 4. 8 percent stole
them, and 17. 3 percent obtained the drug through a
11 Decreased opioid abuse is an important
step toward controlling overall illicit drug abuse, as
almost 75 percent of heroin users reported introduction
to heroin through prescription painkillers.
State and federal initiatives
Many efforts at the federal and state levels have been
implemented to combat the opioid crisis in the U.S.
State-level efforts have focused on patient and provider education and enhanced access to naloxone (in
addition to training on its use), medication assistance
programs, and implementation of prescription drug
monitoring programs. Educating the general public
or targeted populations about the risks of addiction
helps mitigate misuse, because patients are less likely
to abuse these medications if they are perceived to be
Guidelines for providers who prescribe opioids also
have been developed, although they can vary widely.
The Centers for Disease Control and Prevention (CDC)
has issued the only standardized guideline for the use
of prescription narcotics to control chronic pain.
Surgeons should be familiar with these guidelines as
we often operate on patients with chronic pain syn-
dromes. Furthermore, provider education about the
reversal agent naloxone and its proper distribution has
increased steadily and the U.S. Department of Health
and Human Services has identified naloxone as one
of three major priorities in battling the opioid crisis.
Opioid overdose education and community naloxone
distribution is aided by educating bystanders, friends,
family members, acquaintances, and first respond-
ers to recognize the signs of an opioid overdose and
to administer naloxone.
15, 16 Most states have reduced
the opioid crisis by increasing access and distribution
of naloxone kits. While health care professionals may
provide prescriptions for naloxone to family members,
most states allow pharmacists to dispense naloxone
kits without a prescription.
Not only can reversal agents help reduce overdoses,
but the use of a medication assistance program that
uses methadone, buprenorphine, and extended release
injectable naltrexone has proven effective in decreasing
mortality and opioid use.
13, 18 Approximately 1,200 facilities across the U.S. have opioid treatment programs
that provide such assistance.
19 The number of patients
who received methadone and buprenorphine prescriptions has increased in recent years, rising to more than
306,000 patients in 2011 from 7,020 in 2003.19 These
medications have proven beneficial and have helped
individuals regain some normality in their lives.
Other methods that are useful in alleviating the
opioid crisis include monitoring the use of narcotics.
Prescription drug monitoring programs (PDMPs) were
first developed in 1939 at the state level to help tackle
opioid misuse in the U.S.
13, 20 PDMPs are electronic
databases available to providers to help monitor the
prescription of medications with high potential for
abuse, such as Level II and Level III opioids.
that have implemented PDMPs have experienced a
decrease in opioid deaths.
Turn the Tide campaign
State-level and perioperative-focused initiatives may
not be enough to ameliorate the negative effects of the
opioid crisis. In his open letter to health care professionals mentioned at the beginning of this article, U.S.
Surgeon General Vivek H. Murthy, MD, introduced the
Turn the Tide Rx initiative.
16 The campaign calls upon
clinicians to pledge their commitment to the following:
•Educate themselves to treat pain safely and effectively
•Screen patients for opioid use disorder and help them
find appropriate evidence-based treatment
•Educate members of their community on addiction
and help them understand that addiction is a chronic
illness—not a moral failing