24. Khokhar J Y, Ferguson CS, Zhu AZ, Tyndale RF. Pharmacogenetics
of drug dependence: Role of gene variations in susceptibility and
treatment. Annu Rev Pharmacol Toxicol. 2010;50: 39-61.
25. Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of
patient-centered care. N Engl J Med. 2012;366( 9):780-781.
26. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the Opioid Risk Tool.
Pain Med. 2005; 6( 6):432-442.
27. Carr EC, Thomas VJ. Anticipating and experiencing post-operative
pain: The patients’ perspective. J Clin Nurs. 1997; 6( 3):191-201.
28. Shuldham C. A review of the impact of pre-operative education on
recovery from surgery. Int J Nurs Stud. 1999; 36( 2):171-177.
29. Wallace LM. Communication variables in the design of pre-surgical
preparatory information. Br J Clin Psychol. 1986; 25(Pt 2):111-118.
30. Grondin F, Bourgault P, Bolduc N. Intervention focused on the
patient and family for better postoperative pain relief. Pain Manag
Nurs. 2014; 15( 1): 76-86.
31. Verde Technologies. The Deterra Drug Deactivation System. FAQ.
Available at: http://deterrasystem.com/faq/#What-drugs-will-Deterra-deactivate. Accessed June 27, 2017.
32. Vimont C. New drug deactivation system allows patients to safely
dispose of opioids at home. Partnership for drug-free kids: Where
families find answers. July 13, 2016. Available at: http://drugfree.
org/learn/drug-and-alcohol-news/new-drug-deactivation-system-allows-patients-safely-dispose-opioids-home/. Accessed May 10,
33. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after
surgery: A review. JAMA Surg. 2017;152( 3):292-298.
34. McCullough LB, Jones J W, Brody BA. Surgical Ethics. New York:
Oxford University Press; 1998.
35. Oliver JB, Kashef K, Bader AM, Correll DJ. A survey of patients’
understanding and expectations of persistent postsurgical pain in a
preoperative testing center. J Clin Anesth. 2016;34:494-501.
36. Cheatle MD, Savage SR. Informed consent in opioid therapy: A
potential obligation and opportunity. J Pain Symptom Manage.
2012; 44( 1):105-116.
37. Sullivan MD, Gaster B, Russo J, et al. Randomized trial of web-based training about opioid therapy for chronic pain. Clin J Pain.
2010; 26( 6):512-517.
38. Treating chronic pain, managing risk, restoring lives. Collaborative
Opioid Prescribing Education for Risk Evaluation and Mitigation
Strategy. Available at: www.coperems.org/. Accessed May 10, 2017.
not only study these outcomes, but that we
develop targeted interventions to reduce the
patient experience of pain, which has a considerable effect on quality of life.
Undoubtedly, these changes will need to be
considered within the context of the complex
U.S. health care system, as well as regulations
issued by hospital accreditation organizations and state and federal governments. In
the future, surgeons will need to engage with
policymakers to ensure the development of
meaningful initiatives that translate to tangible benefits for our profession and our patients.
The complexity of the opioid epidemic cannot
be underestimated. Meaningful reduction in
opioid use disorders necessitates a diverse and
multifaceted approach. The surgical community must acknowledge the potential harms of
opioid therapy and tailor our practices to ensure
that opioid analgesics are used responsibly.
Improving physician-patient communication
in the preoperative setting is a potentially powerful preventive strategy.
Surgeons are positioned to play a leadership role in reducing opioid-related deaths,
as well as the societal and individual tolls of
opioid addiction. Through special attention to
communication, patient education, opioid risk
assessment and addiction screening, preoperative planning and expectation management,
and reduced opioid prescriptions, surgeons can
significantly limit their contribution to iatrogenic opioid dependence. ♦