The strength of this initiative is its focus on engaging
all stakeholders—including health care providers, policymakers, educators, law enforcement officers, and the larger
community—in a collaborative effort to change the course
of the opioid epidemic.
The Turn the Tide Rx pocket guide includes information
for providers that outlines the CDC guidelines on chronic
pain management. This pocket guide serves as a valuable
resource for physicians, particularly young surgeons, as
they may encounter many chronic opioid users and may
inadvertently enable or facilitate behaviors consistent with
narcotic abuse or addiction.
8 Participating in national campaigns like the Turn the Tide Rx initiative should be an
ethical obligation for all surgeons.
Protocols for perioperative pain management
Considering that nearly 17. 3 percent of opioid-dependent
people initiated use through a physician-provided prescription, new and innovative approaches to maximizing
perioperative pain control while minimizing use of excessive narcotics or medications with highly addictive potential
Initially, the Enhanced Recovery After Surgery (ERAS)
concept evolved as a byproduct of colorectal surgery
research in an effort to decrease postoperative adverse
events, length of stay, and bowel-related complications. The
American College of Surgeons (ACS) has introduced the
ERAS approach to hospitals throughout the U.S. through
the Agency for Healthcare Research and Quality (AHRQ)
Safety Program for Improving Surgical Care and Recovery
(ISCR). The ISCR program supports hospitals in implementing perioperative evidence-based pathways to meaningfully
improve clinical outcomes, reduce hospital length of stay,
and improve the patient experience, and is a collaborative
effort between the Johns Hopkins Medicine Armstrong
Institute for Patient Safety and Quality, Baltimore, MD,
and the College.
Intrinsic to this initiative is an effort to limit the use of
narcotic pain medication. Together, colorectal surgeons and
urologists have been on the cutting edge of ISCR implementation, with significant improvements not only regarding
complications and length of stay, but also in overall use of
1. Murthy VH. Ending the opioid epidemic—A call to
action. N Engl J Med. 2016;375( 25):2413-2415.
2. Waljee JF, Li L, Brummett CM, Englesbe MJ.
Iatrogenic opioid dependence in the United
States: Are surgeons the gatekeepers? Ann Surg.
3. Phillips DM. JCAHO pain management standards
are unveiled. Joint Commission on Accreditation of
Healthcare Organizations. JAMA. 2000;284( 4):428-429.
4. Centers for Disease Control and Prevention. Vital
signs: Overdoses of prescription opioid pain relievers:
United States, 1999–2008. MM WR Morb Mortal Wkly
Rep. 2011; 60( 43):1487-1492.
5. Rudd RA, Aleshire N, Zibbell JE, Gladden RM.
Increases in drug and opioid overdose deaths: United
States, 2000–2014. MM WR Morb Mortal Wkly Rep.
2016; 64( 50-51):1378-1382.
6. Manchikanti L, Helm S II, Fellows B, et al. Opioid
epidemic in the United States. Pain Physician. 2012; 15( 3
7. Substance Abuse and Mental Health
Services Administration. Substance Use and
Mental Disorders in the Phoenix-Mesa-Glendale
MSA. 2012. www.samhsa.gov/data/sites/
8. Gawande AA. It’s time to adopt electronic
prescriptions for opioids. Ann Surg. 2017;265( 4):693-
9. Centers for Disease Control and Prevention. From
the Centers for Disease Control and Prevention.
HIV and AIDS: United States, 1981–2000. JAMA.
10. Bartels K, Mayes LM, Dingmann C, et al. Opioid
use and storage patterns by patients after hospital
discharge following surgery. PLoS One. 2016; 11( 1): 1-10.
11. Substance Abuse and Mental Health Services
Administration. Results from the 2010 National Survey
on Drug Use and Health: Summary of National
Findings, NSDUH Series H- 41, HHS Publication
No. (SMA) 11-4658. Rockville, MD: Substance
Abuse and Mental Health Services Administration
2011. Available at: www.samhsa.gov/data/sites/
continued on next page