outcomes on pain scales, and focus instead on distal outcomes,
such as patient function or overall patient satisfaction.
Considering the toll of the opioid epidemic on patients, it is
essential that research on opioid use, addiction, and alternatives
continue. Some of this research must focus on the role that surgeons
play as opioid prescribers and how our practice patterns can best
be adjusted to treat patients appropriately while also addressing a
broader public health crisis. Additionally, this research must include
a focus on high-risk populations. Veterans, for example, may be
twice as likely to die from a drug overdose than non-veterans, and
a better understanding of pain management and opioid safety in
this population may be particularly important. 16
Signs of progress
In the midst of the opioid crisis, signs of progress are emerging.
In addition to the state mandates for PDMPs described earlier, the
National Association of Boards of Pharmacy established PDMP
InterConnect, helping to link state PDMPs and thereby breaking
down data silos and providing prescribers with integrated, comprehensive information. 17 Increased awareness among physicians and
researchers has led to numerous published studies that evaluate the
relationship between treatment of acute pain, chronic pain, and
opioid use disorder. Even simple provider education about opioid
overuse and the establishment of basic prescribing guidelines has
been shown to be effective in reducing the amount of opioids prescribed.18 The results of these efforts to slow the opioid epidemic
will take time to yield results.
As these changes unfold, it is critical that surgeons and major
prescribers of opioids be part of the solution to this growing crisis.
The College is committed to responsible prescribing and a multi-modal approach focused on policy, professional education, and
patient/caregiver education in developing resources to address
opioid abuse and overuse.
Opiod abuse will be addressed in further detail in the August
Bulletin as the subject of the annual ACS Resident and Associate
Society-themed issue. ♦
11. Centers for Disease Control and Prevention.
Guidelines for Prescribing Opioids on Chronic
Pain—United States 2016. Available at: www.
htm. Accessed May 29, 2017.
12. Hanks S. The law of unintended
consequences: When pain management
leads to medication errors. Pharmacy and
Therapeutics. 2008; 33( 7):420-425.
13. Chou R, Gordon DB, de Leon-Casasola
OA, et al. Management of postoperative
pain: A clinical practice guideline from
the American Pain Society, the American
Society of Regional Anesthesia and Pain
Medicine, and the American Society of
Anesthesiologists’ Committee on Regional
Anesthesia, executive committee, and
administrative council. J Pain. 17( 2):131-157.
14. Murthy VH. Ending the opioid
epidemic—A call to action. N Engl J Med
15. Lee TH. The pain that results from pain
measurement. NEJM Catalyst. May 25, 2016.
Available at: catalyst.nejm.org/the-pain-that-results-from-pain-measurement/.
Accessed May 18, 2017.
16. Bohnert AS, Ilgen MA, Galuea S, McCarthy
JF, Blow FC. Accidental poisoning among
patients in the Department of Veteran
Affairs Health System. Med Care. 2011;
17. National Alliance for Model State Drug
Laws. Compilation of prescription
monitoring program maps. May
2016. Available at: www.namsdl.
694C755E16C2DD21/. Accessed May 18, 2017.
18. Hill MV, Stucke RS, McMahon ML, Beeman
JL, Barth RJ Jr. An educational intervention
decreases opioid prescribing after general
surgical operations. Ann Surg. 2017 [Epub
ahead of print].
19. Sugai DY, Deptula PL, Parsa AA, Parsa DF.
The importance of communication in the
management of postoperative pain. Hawaii J
Med Public Health. 2013; 72( 6):180-184.
V102 No 7 BULLETIN American College of Surgeons