Consider the Opioid Crisis Again? Yes! Why? Because- “Repetitio est mater studiorum” (repetition is the mother of learning)
Alan Jay Schwartz, MD, MSEd and Bonnie L Milas, MD
Today is the first day of Ramadan. To our Muslim readers: Ramadan Kareem (rah-ma-dawn kah-reem) which translates "have a generous Ramadan" or "noble Ramadan." Myron Yaster MD
Recently, Pediatric Anesthesia Article of the Day (PAAD) considered the ongoing opioid crisis. (Fentanyl Drives Startling Increases in Adolescent Overdose Deaths-PAAD, February 20, 2023). In fact, in the past 14 months, the opioid crisis has been a recurring topic of discussion in PAAD. Comb the PAAD archives1 and read:
1. Prescription Opioid Ecosystem-January 6, 2022
2. Left over, unconsumed prescription opioids-January 10, 2022
3. Reader Response-March 17, 2022
4. Reader Response-March 18, 2022
5. Pain management, Opioids Prescriptions and Race-May 9, 2022
6. Intra Nasal Naloxone-January 24, 2023
7. Reader Response-February 17, 2023
Why is fentanyl different than other mu opioid agonist March 21, 2023
National data provides the imperative for such repetition. The National Institutes of Health-National Institute on Drug Abuse most current reporting states:
“Opioid-involved overdose deaths rose from 21,089 in 2010 to 47,600 in 2017 and remained steady through 2019. This was followed by a significant increase in 2020 with 68,630 reported deaths and again in 2021 with 80,411 reported overdose deaths.”2
“Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139. This was followed by a slight increase in 2020, with 16,416 reported deaths. In 2021, the number of reported deaths involving prescription opioids totaled 16,706.”2
Ron Litman’s conceptualization of the value of a recurring publication such as PAAD included, in part, his desire to enhance patient safety through a better understanding of safe administration of medications. To achieve this goal, Ron’s personal activities included becoming the Medical Director of the Institute for Safe Medication Practices https://www.ismp.org/ and becoming a member and ultimately Chair of the FDA’s Anesthetic and Analgesic Drug Advisory Committee (https://www.fda.gov/advisory-committees/human-drug-advisory-committees/anesthetic-and-analgesic-drug-products-advisory-committee).
What is the role that all anesthesiologists must assume in developing solutions to the opioid crisis?
One obvious role is to understand the evidence-based science surrounding opioid use and abuse. The PAAD articles listed above coupled with the vast anesthesiology and other medical literature serve to frame this scholarly understanding.
A second extremely important role for anesthesiologists in developing solutions to the opioid crisis, is to interface with and educate the general non-medical public about best care and treatment options for affected individuals, their families, and communities.
Achieving the second role is a gem of an opportunity for anesthesiologists to interact at critical touch points perioperatively and clinically with patients and their families. When anesthesiologists become aware of and employ the easily accessed educational resource, REVIVEme.com (https://www.asahq.org/advocating-for-you/reviveme), developed by the American Society of Anesthesiologists with a joint supportive statement by the American Heart Association, they have a variety of tools available to teach, support and advocate for the non-medical public’s participation in life-saving care of opioid overdose individuals.
Anesthesiologists can promote and publicly teach practical, effective, and very easily applied nasal Narcan therapy. The FDA is on the brink of a monumental decision to label nasal naloxone as an over-the-counter therapeutic3 and anesthesiologists can assist in the public’s adoption of this potentially lifesaving care.
Anesthesiologists can additionally become familiar with what the lay press is making available for public consumption about the opioid problem and utilize these venues to teach the public about the opioid problem in a much more understandable manner than quoting the scientific literature. “Empire of Pain” and “Dopesick” are examples of current lay public publications and “Dopesick” is additionally a TV Mini Series. They tell the opioid story from a variety of foci including the tale of the exploitation of the public by the pharmaceutical industry and a taking a deep dive into the public health consequences of opioids upon the abusers, their families, and communities.4,5
Anesthesiologists would serve the public well by sharing the March 31, 2022, University of Pennsylvania Master in Law lecture, “The Opioid Crisis: Pain, Profits, and Regulatory Failures” presented by “Empire of Pain” author, Patrick Radden Keefe, a memorial lecture, tribute, and honor to Ron Litman.6
The opioid crisis is the perfect opportunity for anesthesiologists to come out from behind the “ether screen” and become quite visible to the public. Facilitating the public’s understanding of the disease of opioids and encouraging them to acknowledge this reality to treat and prevent its consequences will save lives, a noble activity for anesthesiologists to embark upon.
References
1. https://ronlitman.substack.com/archive (accessed February 22, 2023)
2. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#:~:text=Opioid%2Dinvolved%20overdose%20deaths%20rose,with%2080%2C411%20reported%20overdose%20deaths. (accessed February 22, 2023)
3. Perrone M: Panel backs moving opioid antidote Narcan over the counter. The Washington Post. February 15, 2023 https://www.washingtonpost.com/health/fda-panel-weighs-moving-opioid-antidote-over-the-counter/2023/02/15/be497bce-ad52-11ed-b0ba-9f4244c6e5da_story.html (accessed February 17, 2023)
4. Schwartz AJ: Opioids: The Elephant in the Room. ANESTHESIOLOGY 2023; 137: 754-5
5. https://www.imdb.com/title/tt9174558/?ref_=tt_mv_desc (accessed February 21, 2023)
6.
(accessed February 21, 2023)