Opioid-related deaths and treatment admissions have shown constant growth since 1999. According to the federal government’s National Survey on Drug Use and Health, 4 out of 5 current heroin users report that their opioid use began with opioid pain relievers.1
In response to the crisis, healthcare professionals are evaluating current practices and implementing strategies designed to mitigate the increase in cases of addiction.2 Almost all 50 states have instituted a prescription drug-monitoring program (PDMP) to help identify overprescribing and diversion, and aid health care professionals in decision making.3 States have also taken other steps4:
- 19 states implemented day-supply limits to written opioid prescriptions
- 34 states now require a substance abuse disorder assessment prior to opioid prescription
- 36 states allow (or even mandate) pharmacists to check a patient’s ID before dispensing prescriptions
The challenge to pharmacists
These statutes place pharmacists in a primary position to ensure patients make a healthy recovery. Opioid pain relievers are common protocol for acute postoperative pain management. It is important that pharmacists establish more non-opioid options on formularies to empower surgeons with the tools they need to treat acute postoperative pain effectively and safely.
Local anesthetics have the potential to create a strong foundation for pain management after surgery. The local inflammation process produces acidic metabolites that increase hydrogen ion concentration at the site of injury.4 The pH of inflammatory exudate decreases with time, reaching its lowest value at 72 hours.5 This causes most local anesthetics—including extended-release formulations—to struggle to work beyond 12 to 24 hours.4 With severe pain often lasting beyond 24 hours, we rely on opioids to pick up where local anesthetics leave off.
But what if local anesthetics could last longer?
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References: 1. Muhuri PK, Gfroerer JC, Davies MC; Center for Behavioral Health Statistics and Quality. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Rev. SAMHSA website. http://www.samhsa.gov/
data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm. Published August 2013. Accessed February 12, 2019. 2. Kolodny A, Courtwright DT, Hwang CS, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559-574. doi:10.1146/annurev-publhealth-031914-122957. 3.Infographic: state-by-state breakdown of opioid regulations. athenahealth website. https://www.athenahealth.com/insight/infographic-opioid-regulations-state-by-state. Published January 7, 2019. Accessed February 12, 2019. 4. Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Progress. 2006;53(3):98-109. doi:10.2344/0003-3006(2006)53[98:EOLAP]2.0.CO;2. 5. Edlow DW, Sheldon WH. The pH of inflammatory exudates. Proc Soc Exp Biol Med. 1971;137(4):1328-32. doi:10.3181/00379727-137-35782.