We read with interest the recent editorial by Kharasch et al. concerning opioid management. We agree with their assessment of “opioid phobia,” and we would say “not so fast with opioid-free anesthesia.” There is no doubt that opioids are highly addictive drugs, as shown by recurring waves of opioid abuse since the nineteenth century. We appreciate that those promoting opioid-free anesthesia are well intentioned. However, neither the elimination nor the reduction of perioperative opioids have been clearly associated with decreased long-term use and abuse. As noted by Kharasch et al., the increase in prescription opioids in the attempt to address inadequate perioperative pain management was a major factor in the evolution of the opioid abuse crisis. Ironically, perioperative pain continues to be undertreated at this time. Despite the potential advantages of multimodal analgesia,...

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