Evaluating the opioid epidemic: a urologist’s promise to curb the crisis

Abstract

Acute overdose due to opioid ingestion is a leading cause of emergency room visits in North America. Contrary to popular belief, most opioid abuse derives from prescription medication rather than illicit drug use (1). The exact etiology of opioid abuse stems from not taking the medication as prescribed or by using opioids that were allotted to another patient. The misuse of opioids has spawned the CDC to label it the "fastest growing drug problem in the United States". In fact, overdose secondary to opiate medication has dramatically increased since 1999, with 6-fold increase in the number of deaths occurring in 2017 (2). Therefore, adaptation by the physician, as the gatekeeper of prescriptions, represents an integral component to circumvent this growing epidemic.Welk et al. indirectly defined the addictive nature of opioid medication in their manuscript entitled "An opioid prescription for men undergoing minor urologic surgery is associated with an increased risk of new persistent opioid use" (3). Utilizing a variety of population-level databases centralized to Ontario, Canada, the authors examined the implicit nature of opioid dependence after urologic surgery. Using minor procedures, such as transurethral prostatectomy, internal urethrotomy, and scrotal surgery as a reference, the authors measured the receipt of a second opioid prescription filled 9 to 15 months postoperatively. Key to the findings of the manuscript is that men who filled the initial opioid prescription were significantly more likely to fill a second opioid prescription and more likely to require an emergency visit or hospital admission for opioid intoxication (3). In fact, "for every 148 men who received a post-procedure opioid