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A System-Level Approach to Reducing Physician Propagation of the Opioid Crisis: A Brief History of Increased Opioid Prescribing in the U.S. and a Review of Expedited Recovery After Surgery Protocol Effects on Opioid Prescribing

Rogers, Devin (2020) A System-Level Approach to Reducing Physician Propagation of the Opioid Crisis: A Brief History of Increased Opioid Prescribing in the U.S. and a Review of Expedited Recovery After Surgery Protocol Effects on Opioid Prescribing. Master Essay, University of Pittsburgh.

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The opioid crisis has gripped the United States for decades. In the late 1990’s through 2010, opioid prescribing rates and overdose death rates skyrocketed in tandem by four times. In 2008 alone, researchers approximated 830,652 years of potential life lost (YPLL) for opioid overdose related deaths. The cause for these trends is multifactorial and includes recommendations from the American Pain Society and the Joint Commission to be more proactive about pain control with the use of opioids. The over-prescribing of opioids was one major contributor to the uprising on opioid use disorder and overdose death rates in the United States. These two entities have since changed their recommendations in light of the opioid crisis and many have been researching ways to combat the opioid crisis.
Adequate pain control is humane and must be taken seriously. After surgery, many patients have variable levels of pain. Over the years, experts have found that multi-modal approaches to analgesia in the surgical setting provides superior pain control while decreasing exposure to opioids. Researchers have also found increased risk for long-term opioid use after exposure to opioids. It has also been documented that there is immense variability among prescribers and institutions surrounding peri-operative analgesia regimens for common procedures and surgeries. The ERAS (Expedited Recovery After Surgery) Society was created by experts in the field to provide evidence-based guidelines for the peri-operative management of patients with three main pillars: fluid homeostasis, pain control, and return of function. Under the pain-control pillar, the ERAS society employs multi-modal pain control methods to manage pain in the peri-operative setting.
ERAS protocols have been developed for numerous procedures and surgeries across many different specialties of medicine. After implementation across the world, numerous studies have shown the benefits of using ERAS protocols. Studies have shown that not only does the utilization of ERAS protocols greatly reduce opioid exposure and prescribing, it also provides better pain control for patients. ERAS protocols should be developed for more procedures and surgeries to provide better peri-operative pain control for patients while reducing variability in prescribing patterns.
The public health impact of the adoption and implementation of ERAS pathways for many routine surgeries is immense. The use of ERAS pathways in the peri-operative setting has led to decreased opioid usage, reducing opioid exposure for patients. With less exposure, there is less risk for long-term opioid use and opioid related death. Developing these pathways for more types of surgeries and implementing their use may lead to less long-term opioid use after surgery.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Rogers, Devinder65@pitt.eduder65
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairFinegold, Daviddnf@pitt.edudnfUNSPECIFIED
Committee MemberHawk, Marymary.hawk@pitt.edumeh96UNSPECIFIED
Date: 14 August 2020
Date Type: Submission
Number of Pages: 25
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 10 Sep 2020 19:44
Last Modified: 10 Sep 2020 19:44


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