While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.
Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management
Submitted for publication June 27, 2021. Accepted for publication October 18, 2021.
Michael M. Todd, M.D., and Deborah J. Culley, M.D., served as Handling Editors for this article.
- Views Icon Views
- Share Icon Share
- Search Site
Evan D. Kharasch, J. David Clark, Jerome M. Adams; Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management. Anesthesiology 2022; 136:10–30 doi: https://doi.org/10.1097/ALN.0000000000004065
Download citation file: