VADM Jerome M. Adams, MD, MPH (center), with Drs Eugene Viscusi and Jaime Baratta at the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, held April 11-13, 2019, in Las Vegas, NV.

ASRA was very fortunate this past spring to have Surgeon General Jerome Adams, MD, join us at the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas. Not only did Dr. Adams speak passionately and persuasively about the issues facing our field and our society, but also he participated as an attendee. As an anesthesiologist himself, Dr. Adams is especially popular among our members and attendees, and if you saw him walking the halls of the meeting, he was always surrounded by those looking to grab a selfie and shake his hand.

Certainly Dr. Adams’s presence at the meeting was far more important because of his message than his selfies, of course. If you didn’t have the pleasure of hearing his presentation on Thursday, April 11, you’ll find it on our archived webcast page. I know you will find him to be a thought-provoking and engaging speaker. More importantly, however, I hope you will be inspired to take action.

One of Dr. Adams’s key messages, which I wholeheartedly support, is that we all have a role to play in responding to the opioid epidemic.

While it is easy to pick one group to blame (the pharma companies, the surgeons, the drug-dealers, the patients, the community, etc.), the fact is that the opioid epidemic was caused by multiple factors and it will take multiple players to solve it. Dr. Adams compared this to his experience getting buy-in for regional anesthesia. ASRA members are very familiar with the collaborative role that is essential to making real change for the benefit of patients.

The Office of the Surgeon General has identified five ways you can prevent opioid misuse (Figure 1). Please share this resource with your patients and ask your colleagues to do so as well. It is Dr. Adams’s goal that this information be in the hands of every American, so let’s do our part to help make that reality. You can download the card here.

Figure 1: What Can You Do to Prevent Opioid Misuse

Figure 2: Surgeon General’s Advisory on Naloxone and Opioid Overdose.

To that end, here are three key ways that you personally can make a difference in the opioid epidemic:

1. Carry naloxone: During his presentation, Dr. Adams asked attendees to raise their hands if they knew CPR. Then, he asked for a show of hands of people who carried naloxone. At a meeting of doctors, everyone could save a patient having a heart attack. However, only two other attendees in the room could save a patient experiencing an opioid overdose. We are taught that anoxic brain injury occurs in 4-6 minutes, which is generally not enough time for an ambulance to get to the overdose victim. However, naloxone can be administered by anyone using a simple injector or nasal spray. Read the Surgeon General’s advisory here (Figure 2). 
2. Use and educate about multimodal anesthesia: Not only do we need to continue to research new nonopioid options for patients, but we need to educate our patients and colleagues about the essential role of multimodal management. “In 5 years, physicians have decreased opioid prescriptions nationwide by 22%,” Adams said. “Regional anesthesiologists and pain medicine doctors … have played a large role in this reduction by educating your colleagues about pain medicine modalities that help to minimize and often completely avoid the need for opioids.” We need to continue to educate our patients and colleagues about the effectiveness of maintenance ibuprofen and acetaminophen following surgery. We need to continue to support research into opioid alternatives. In addition to the $240,000 of research grant money available annually from ASRA, the National Institutes of Health has its HEAL (Helping to End Addiction Long-term) Initiative. It is essential that as we move away from opioids, we have many other effective options to help those who are experiencing pain so they don’t need to turn to illicit drugs or dangerous activities.
3. Get your X Waiver: All doctors should obtain their Buprenorphine Waiver to be able to prescribe and dispense buprenorphine for opioid dependency treatment. The Substance Abuse and Mental Health Services Administration’s (SAMHSA's) website provides details on the program, which requires an application and 8 hours of training. Buprenorphine is used in medication-assisted treatment, which is a key part of reducing opioid addiction. However, only about 5% of U.S. doctors have the prescription waiver according to SAMHSA. This significantly limits an effective tool for managing opioid use disorder. I urge everyone reading this to learn more about this critical step in managing patients’ use of opioids.

"In 5 years, physicians have decreased opioid prescriptions nationwide by 22%,” Adams said. “Regional anesthesiologists and pain medicine doctors … have played a large role in this reduction by educating your colleagues about pain medicine modalities that help to minimize and often completely avoid the need for opioids.”

Now more than ever, we, as acute and chronic pain specialists, have the opportunity to be role models and leaders for our colleagues, our patients, and our society. Medication assisted treatment (MAT) with buprenorphine or methadone saves lives. Reflecting on the above, I would ask you to consider two extremely important ways we can save lives:

1. Obtain your DEA X-wavier to prescribe buprenorphine. Initiate treatment in the outpatient setting when whenever indicated and possible.
2. If you work in the inpatient setting and provide anesthesia or acute pain management for patients with substance use disorder, make every effort to convert from other opioids to buprenorphine prior to hospital discharge with referral for treatment. Buprenorphine is an adequate analgesic. The highest risk period for death in patients with SUD is in the first 28 days following a hospital admission. Getting patients into MAT saves lives.

As a Society, if we promote these two action points, ASRA and YOU will make an impact and save lives. I look forward to joining you in this important initiative.