Driven by dangerously potent opioids like the synthetic substance fentanyl, deaths from drug overdoses are skyrocketing. Fatal overdoses among adolescents doubled between 2019 and 2020. And Black men – who in the past had a lower risk of drug-related death than white men – were one of the two most likely demographic groups to fatally overdose in 2020, according to the Pew Research Center, with their rate of death more than tripling since 2015. These types of victims are among the more than 107,000 Americans estimated to have succumbed to drugs last year alone, helping to mark another new record high.
Yet our collective response seems more consistent with apathy than intervention. We’ve come to accept ever-escalating opioid-related deaths as inevitable as opposed to actionable.
It’s daunting, of course, to confront another epidemic whose etiology and risk factors reflect a combination of environmental influence and independent action – but it’s not impossible.
Opioids entered Americans’ homes and medicine cabinets with increasing regularity in the 1990s, when prescription-fueled deaths began their ascent. Deaths from heroin and synthetic opioids, such as fentanyl, took over later.
Risk factors for opioid addiction and death are similarly evolving. While nobody is immune to addiction, elevated risk is seen in those who’ve experienced issues like mental trauma or illness, childhood adversity, unemployment and a history of substance use disorder. COVID exacerbated these types of risk factors by fueling isolation and economic hardship, all while depleting access to addiction treatment and services.
Drug deaths have surged, however, not merely because of human behavior, but because today’s drugs are significantly more dangerous than their historical counterparts. With both opioid and non-opioid (Xanax, cocaine, etc.) street drugs being laced with fentanyl, new experimenters are facing hazards and risks previously associated with only long-term addiction.
There are excellent articles articulating evidence-based policies and programs to fight addiction. This is not one of them. My hope is to equip you with tools and knowledge for self-advocacy, to reduce your and your loved ones’ opioid exposure during and after surgery, with the ultimate goal of reducing your risk of potential dependence.
Surgery is one of the few instances in which opioid exposure is almost assured. And while a small percentage of individuals develop opioid addiction following surgery, the average American will undergo around nine surgical procedures in an 85-year lifespan.
Given this ubiquity, people should demand evidence-based perioperative practices that reduce exposure to opioids. As an anesthesiologist who administers opioids and manages pain daily, I recommend the following questions that anyone undergoing surgery should ask their physician.
Addiction Amid COVID-19
Am I a candidate for regional anesthesia?
Regional anesthesia uses local anesthetic injections to numb parts of the body, such as an arm, leg or everything below the waist. It blocks the transmission of pain signals from a specified area of the body to the brain, where the sensation of pain is generated. Common regional anesthetics include epidurals or spinals for vaginal or cesarean deliveries. But increasingly, we’re turning to regional blocks to manage postoperative pain for everything from major abdominal surgery and mastectomies to extremity procedures.
Regional anesthetics can decrease opioid use and provide far denser pain control than narcotic-based regimens. They can be administered as single injections that wear off in three hours to 20 hours (depending on medication type), or with a catheter that lasts for days.
Can I use a mix of medications – or multimodal anesthesia – to reduce opioid consumption?
Employing a combination of pain medications acting via varied biologic targets can decrease reliance on opioids. While local anesthetics generate the densest pain relief, combining different categories of oral medications can also be incredibly effective.
How much pain can I expect, and how much medication will I receive?
Even with regional blocks and multimodal pain regimens, some postoperative pain is expected. Knowing how severe it might be, how long it will last and how much pain medication you will go home with is necessary both for your knowledge and so your expectations align with those of your physician.
Your physician is the best source for describing the type and degree of pain you should anticipate. However, consensus generally dictates that while some discomfort should be expected, pain should be medicated enough so that a person can cough with mild discomfort and walk (with assistance).
The Michigan Open Prescribing Engagement Network is also an excellent source of information on pain and medication needs following surgical procedures. A collaboration backed by the University of Michigan, Blue Cross Blue Shield of Michigan and the Michigan Department of Health & Human Services, it uses evidence including patient data to determine typical medication needs.
Over the past decade, the medical community has scrambled unsuccessfully to reverse an epidemic we helped launch. Some of our failure is due to social circumstances and policies outside our control, but some responsibility remains with us. We need greater uniformity in adopting best practices related to pain management, and we need to better educate patients on how to reduce their own utilization of opioids and risk of dependency.
Asking these questions will not eliminate the need to take opioid medications in all circumstances. But it will improve your ability to advocate for yourself and those you care for.