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Lessons Learned from the U.S. Opioid Epidemic

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Lessons Learned from the U.S. Opioid Epidemic

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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.

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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Lessons Learned from the U.S. Opioid Epidemic

  1. 1. @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
  2. 2. @EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
  3. 3. @EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
  4. 4. @EMARIANOMD
  5. 5. @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
  6. 6. @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
  7. 7. @EMARIANOMD Brummett, et al. JAMA 2017 Klueh, et al. JGIM 2018 The Role of Surgery
  8. 8. @EMARIANOMD Updates Coming Soon! “Acute pain can often be managed without opioids…. More than 7 days will rarely be needed.”
  9. 9. @EMARIANOMD https://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx
  10. 10. @EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
  11. 11. @EMARIANOMD Mudumbai & Mariano, et al. Pain Med 2016 The Opioid Epidemic
  12. 12. @EMARIANOMD The Opioid Epidemic https://www.cdc.gov/drugoverdose/epidemic/index.html
  13. 13. @EMARIANOMD The Opioid Epidemic Mudumbai & Mariano, et al. Pain Med 2016
  14. 14. @EMARIANOMD Unintended Consequences
  15. 15. @EMARIANOMD
  16. 16. @EMARIANOMD Elkassabany & Mariano. Anaesthesia 2019
  17. 17. @EMARIANOMD Elkassabany & Mariano. Anaesthesia 2019
  18. 18. @EMARIANOMD Opioid-Free Anaesthesia: PRO? Lavand’homme. EJA 2019
  19. 19. @EMARIANOMD Opioid-Free Anaesthesia: CON Lirk & Rathmell. EJA 2019
  20. 20. @EMARIANOMD Fiore, et al. BJA 2019
  21. 21. @EMARIANOMD Fiore, et al. BJA 2019
  22. 22. @EMARIANOMD Kharasch, et al. Anesthesiology Feb 2020
  23. 23. @EMARIANOMD Kharasch, et al. Anesthesiology Feb 2020
  24. 24. @EMARIANOMD Overview • How did this happen? • Where are we now? • What do we do to move forward?
  25. 25. @EMARIANOMD
  26. 26. @EMARIANOMD Thinking Beyond Blocks Yajnik, et al. Patient Educ Couns. 2018
  27. 27. @EMARIANOMD Thinking Beyond Blocks Yajnik, et al. Patient Educ Couns. 2018
  28. 28. @EMARIANOMD Mariano, Schatman. J Pain Res 2019
  29. 29. @EMARIANOMD Elkassabany & Mariano. Anaesthesia 2019 Opioid-Free Potential
  30. 30. @EMARIANOMD Patient Education is Lacking
  31. 31. @EMARIANOMD Think Beyond the PACU Mariano, Walters, Kim, Kain. A&A 2015 Walters, Mariano, Clark. Pain Med 2015
  32. 32. @EMARIANOMD Tamboli, Mariano, et al. Pain Med 2019
  33. 33. @EMARIANOMD How Long Does Acute Pain Last? Mariano, El-Boghdadly, Ilfeld. Anaesthesia 2020
  34. 34. @EMARIANOMD Transitional Pain Katz, et al. J Pain Res 2015 Huang, et al. Pain Manag 2016
  35. 35. @EMARIANOMD Newer Interventions Gabriel & Ilfeld. Best Pract 2019
  36. 36. @EMARIANOMD Ilfeld, et al. J Orthop Surg Res 2017
  37. 37. @EMARIANOMD
  38. 38. @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.
  39. 39. @EMARIANOMD
  40. 40. @EMARIANOMD
  41. 41. @EMARIANOMD ASA-Premier Pilot Collaborative
  42. 42. @EMARIANOMD ASA-AAOS Collaboration
  43. 43. @EMARIANOMD Turn Research into Action 2020: Now a National Quality Metric
  44. 44. @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?

Editor's Notes

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

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