Prevention, diagnosis, and treatment of opioid use disorder under the supervision of opioid stewardship programs: it's time to act now

Abstract

The third opium war may have already started, not only due to illicit opioid trafficking from the Golden Crescent and Golden Triangle on the international front but also through indiscriminate opioid prescription and opioid diversion at home. Opioid use disorder (OUD), among unintentional injuries, has become one of the top 4 causes of death in the United States (U.S.). An OUD is defined as a problematic pattern of opioid use resulting in clinically significant impairment or distress, consisting of 2 or more of 11 problems within 1 year, as described by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Observation of aberrant behaviors of OUD is also helpful for overworked clinicians. For the prevention of OUD, the Opioid Risk Tool and the Current Opioid Misuse Measure are appropriate screening tests before and during opioid administration, respectively. Treatment of OUD consists of 3 opioid-based U.S. Food and Drug Administration-approved medications, including methadone, buprenorphine, and naltrexone, and non-opioid-based symptomatic medications for reducing opioid withdrawal syndromes, such as α 2 agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs, and benzodiazepines. There are at least 6 recommendable guidelines and essential terms related to OUD. Opioid stewardship programs are now critical to promoting appropriate use of opioid medications, improving patient outcomes, and reducing misuse of opioids, influenced by the successful implementation of antimicrobial stewardship programs. Despite the lack of previous motivation, now is the critical time for trying to reduce the risk of OUD.

Practical strategies for the prevention and management of chronic postsurgical pain

“…As in the recently proposed modified World Health Organization analgesic ladder for chronic non-cancer pain, the intensity of analgesic medications can be upgraded step-by-step depending on the patient's response to treatment, starting with a non-opioid analgesic method [91]. Strong opioids should be used carefully in a limited number of patients in the last step, weighing their benefits and risks [92]. In addition, since the prevalence of the neuropathic component in CPSP has been known to be high [93,94], various pharmacologic and interventional treatments used for neuropathic pain can be useful in the treatment of CPSP [95].…”

No more tears from surgical site infections in interventional pain management

“…An antibiotic stewardship program by infection specialists is already well-established in Korea, even though the opioid stewardship program by pain physicians is still in an initial state [ 150 ]. Thanks to restrictions on the misuse or abuse of broad-spectrum antibiotics, various types of antibiotic resistance have become reduced ( Table 12 ) [ 151 ].…”

Still a threatening opioid wave: it is time for the protagonist to step up!

“…Although some guidelines have been presented, there are many points to consider including whether they were made by administrative experts or by pain experts who prescribe opioids in the field. Fortunately, in the latest issue of the Korean Journal of Pain , Kim et al [ 10 ] contributed an excellent review regarding the misuse of opioids. They addressed the opioid issue, including those that have been overlooked including opioid misuse in the perioperative period and by cancer survivors.…”