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Lessons Learned from the U.S. Opioid Epidemic

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Edward R. Mariano, MD
Edward R. Mariano, MD

I had the honor of being a keynote lecturer at the 2021 Association of Anaesthetists Winter Scientific Meeting. For this talk, I provided some historical background on various contributing factors to the U.S. opioid epidemic, the current state including the many legislative and regulatory responses, and potential opportunities to innovate in clinical care moving forward.

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@EMARIANOMD Lessons learned from the U.S. opioid epidemic Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative & Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System
@EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
@EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
@EMARIANOMD
@EMARIANOMD The Opioid Epidemic https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0 https://www.cdc.gov/drugoverdose/epidemic/index.html
@EMARIANOMD The Opioid Epidemic https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0 https://www.cdc.gov/drugoverdose/epidemic/index.html
@EMARIANOMD Brummett, et al. JAMA 2017 Klueh, et al. JGIM 2018 The Role of Surgery
@EMARIANOMD Updates Coming Soon! “Acute pain can often be managed without opioids…. More than 7 days will rarely be needed.”
@EMARIANOMD https://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx
@EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
@EMARIANOMD Mudumbai & Mariano, et al. Pain Med 2016 The Opioid Epidemic
@EMARIANOMD The Opioid Epidemic https://www.cdc.gov/drugoverdose/epidemic/index.html
@EMARIANOMD The Opioid Epidemic Mudumbai & Mariano, et al. Pain Med 2016
@EMARIANOMD Unintended Consequences
@EMARIANOMD
@EMARIANOMD Elkassabany & Mariano. Anaesthesia 2019
@EMARIANOMD Elkassabany & Mariano. Anaesthesia 2019
@EMARIANOMD Opioid-Free Anaesthesia: PRO? Lavand’homme. EJA 2019
@EMARIANOMD Opioid-Free Anaesthesia: CON Lirk & Rathmell. EJA 2019
@EMARIANOMD Fiore, et al. BJA 2019
@EMARIANOMD Fiore, et al. BJA 2019
@EMARIANOMD Kharasch, et al. Anesthesiology Feb 2020
@EMARIANOMD Kharasch, et al. Anesthesiology Feb 2020
@EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
@EMARIANOMD
@EMARIANOMD Thinking Beyond Blocks Yajnik, et al. Patient Educ Couns. 2018
@EMARIANOMD Thinking Beyond Blocks Yajnik, et al. Patient Educ Couns. 2018
@EMARIANOMD Mariano, Schatman. J Pain Res 2019
@EMARIANOMD Elkassabany & Mariano. Anaesthesia 2019 Opioid-Free Potential
@EMARIANOMD Patient Education is Lacking
@EMARIANOMD Think Beyond the PACU Mariano, Walters, Kim, Kain. A&A 2015 Walters, Mariano, Clark. Pain Med 2015
@EMARIANOMD Tamboli, Mariano, et al. Pain Med 2019
@EMARIANOMD How Long Does Acute Pain Last? Mariano, El-Boghdadly, Ilfeld. Anaesthesia 2020
@EMARIANOMD Transitional Pain Katz, et al. J Pain Res 2015 Huang, et al. Pain Manag 2016
@EMARIANOMD Newer Interventions Gabriel & Ilfeld. Best Pract 2019
@EMARIANOMD Ilfeld, et al. J Orthop Surg Res 2017
@EMARIANOMD
@EMARIANOMD National Leadership Is Required Elements of Performance for LD.04.03.13 1. The hospital has a leader or leadership team that is responsible for pain management and safe opioid prescribing and develops and monitors performance improvement activities.
@EMARIANOMD
@EMARIANOMD
@EMARIANOMD ASA-Premier Pilot Collaborative
@EMARIANOMD ASA-AAOS Collaboration
@EMARIANOMD Turn Research into Action 2020: Now a National Quality Metric
@EMARIANOMD Summary • We discussed lessons learned from the U.S. opioid epidemic and answered the following questions: –How did this happen? –Where are we now? –What do we do to move forward?

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Lessons Learned from the U.S. Opioid Epidemic

Editor's Notes

  1. A recent study published by our group showed that less than ½ education materials given to patients mention opioid tapering or cessation