by nonmedical personnel such as police officers is permitted
under legislation passed by the Illinois General Assembly in
2010. Funded through private donations, grants, and local
revenues, the program resulted in 145 “saves” from opioid
overdoses in 2016.39 Individual surgeons, like Dr. Jorgensen,
are working tirelessly throughout the U.S. to eradicate the
source of diverted drugs by encouraging careful prescribing
habits and competently treating the patients most deeply
affected by opioid addiction.
Fellows of the American College of Surgeons (ACS) have
been instrumental in leading efforts to prevent and treat the
epidemic. Atul A. Gawande, MD, MPH, FACS, a general
and endocrine surgeon, Brigham and Women’s Hospital,
Boston, MA, and a leader in the discussion of surgical quality improvement, recently weighed in on the importance
of surgical leadership in controlling the opioid crisis.
example, although all states allow electronic prescription
writing for opioids, less than 10 states require it, and more
than 90 percent of physicians’ practices do not use electronic
prescriptions for these drugs. Dr. Gawande exhorts surgeons to take the lead in the implementation of electronic
opioid prescriptions, even without a government mandate.
Jennifer F. Waljee, MD, MPH, MS, FACS, assistant
professor, plastic surgery, and Michael J. Englesbe, MD,
FACS, associate professor, transplant surgery, University
of Michigan, are using grant funding to explore innovative ways to reduce excess opioid prescriptions and
subsequent diversion. Through the Michigan Opioid
Prescribing Engagement Network (also known as
41, Drs. Waljee and Englesbe are promoting preoperative discussions with patients regarding
postoperative pain expectations, organizing the collection of excess opioid medications, and educating surgeons
to prescribe fewer opioids.
6 Drs. Waljee and Englesbe
also recently published their research showing 6 percent
of opioid-naive patients (no opioid prescriptions filled
between one to 12 months before an operation) were
still taking opioids more than 90 days after a surgical
42 By identifying patient-level risk factors for
persistent postoperative opioid use, such as tobacco use,
anxiety, depression, chronic pain, and others, these surgeons are contributing to a deeper understanding of the
opioid epidemic. This research is crucial in advocating
11. Veterans Health Administration, United States
Department of Veterans Affairs. Pain as the 5th
vital sign toolkit. October 2000. Available at: www.
the_5th_Vital_Sign_Toolkit.pdf. Accessed April 30,
12. Baker DW. History of The Joint Commission’s pain
standards: Lessons for today’s prescription opioid
crisis. JAMA. 2017;317( 11):1117-1118.
13. Compton WM, Boyle M, Wargo E. Prescription
opioid abuse: Problems and responses. Prev Med
(Baltim). 2015;80: 5-9.
14. Rutkow L, Chang HY, Daubresse M, Webster
DW, Stuart EA, Alexander GC. Effect of Florida’s
prescription drug monitoring program and pill
mill laws on opioid prescribing and use. JAMA
Intern Med. 2015;175( 10):1642-1649.
15. Jones C, Paulozzi L, Mack K. Sources of
prescription opioid pain relievers by frequency of
past-year nonmedical use: United States, 2008–
2011. JAMA Intern Med. 2014;174( 5):802-803.
16. Muhuri PK, Gfroerer JC, Davies C. Associations
of nonmedical pain reliever use and initiation of
heroin use in the United States. CBHSQ Data Review.
August 2013. Available at: www.samhsa.gov/data/
reliever-use-2013.htm. Accessed June 21, 2017.
17. Levy B, Paulozzi L, Mack KA, Jones CM. Trends in
opioid analgesic-prescribing rates by specialty, U.S.,
2007–2012. Am J Prev Med. 2015; 49( 3):409-413.
18. Wunsch H, Wijeysundera DN, Passarella MA,
Neuman MD. Opioids prescribed after low-risk
surgical procedures in the United States, 2004–
2012. JAMA. 2016;315( 15):1654-1657.
19. Alam A, Gomes T, Zheng H, Mamdani MM,
Juurlink DN, Bell CM. Long-term analgesic use
after low-risk surgery: A retrospective cohort
study. Arch Intern Med. 2012;172( 5):425-430.
20. Edlund MJ, Martin BC, Russo JE, DeVries A, Braden
JB, Sullivan MD. The role of opioid prescription
in incident opioid abuse and dependence among
individuals with chronic noncancer pain: The role of
opioid prescription. Clin J Pain. 2014; 30( 7):557-564.
21. Shah A, Hayes CJ, Martin BC. Characteristics of
initial prescription episodes and likelihood of long-term opioid use: United States, 2006–2015. MM WR
Morb Mortal Wkly Rep. 2017; 66( 10):265-269.
continued on next page