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patients will have access to sufficient opioids to provide
adequate pain relief during the end of life.

Lessons learned from the opioid epidemic
We have learned from the current crisis that we must be
very careful when legislating health care. When JCAHO
and the California legislature made pain as the fifth vital
sign they did so with good intentions. Health care is a
rapidly progressing field, however, and any legislation
often has unexpected consequences. Legalizing
marijuana, for example, led some drug cartels to sell
more opioids instead of marijuana, and this may be one
of the factors sustaining the current opioid epidemic.
Reducing access to prescription opioids may also lead
more patients to acquire opioids on the street from drug
cartel sources or resort to heroin.14

References
1 Phillips DM. JAMA. 2000; 284(4):428-9.
2 Max MB. Ann Intern Med. 1990 Dec 1;113(11):885-9.
3 Porter J, Jick H. N Engl J Med. 1980;302:123.
4 Brennan F, Carr DB, Cousins M. Anes Analg

2007;105(1):205-21.

5 Peltz G, Südhof TC. JAMA 2018;319(20):2071-2.
6 Liu Y, Lin D, Wu B, Zhou W. Brain Res Bull

2016;126(Pt1):68-73.

7 Mulier J. Rev Esp Anestesiol Reanim 2017;64(8):427-30.
8 Mercandante S, Arcuri E, Santoni A. CNS Drugs 2019;Oct

1. Doi:10.1007 /s40263-019-00660-0. [Epub ahead of
print]

9 Santonocito C, Noto A, Crimi C, Sanfillipo F. Local Reg

Anesth 2018;11:15-23.

Recent statistics
There is some hope on the horizon. Overdose deaths are
fewer in number this year. There has been a 3.9% drop.15
This could be due to a successful campaign distributing
naloxone to addicts and their friends to treat respiratory
depression.16 Opioid prescriptions are trending down,
but there is no way to know the actual quantity of illegal
opioids that are consumed across the United States
every year.

Conclusion

10 Hwang W, Lee J, Park J, Joo J.. BMC Anesthesiology

2015;15:21

11 Bernstein MH, Beaudoin FL, Magill M. Addiction

2019;114(4):757-58.

12 Mendelson J, Flower K, Pletcher MJ, Galloway, GP.

Addiction to prescription opioids: characteristics of
the emerging opioid epidemic and treatment with
buprenorphine. Exp Clin Pharmacol 2008;16(5):435-441.

13 Brandal D, Keller MS, Lee C, Grogan T, Fujimoto Y,

Gricourt Y, et al.. Anesth Analg 2017;125(5):1784-92.

14 Lorraine I. Kelley-Quon, Junhan Cho et. al . JAMA

Pediatric 2019; 173 (9) :1750

15 Centers for Disease Control (CDC) Provisional drug

overdose death counts. Vital statistics rapid release.

16 Adams JM. JAMA 2018;319(20):2073-74.

Anesthesiologists have a responsibility to honestly
discuss the risks of addiction with our patients. The
"Managing your Pain After Surgery" video by the
CSA goes a long way to explain all the issues and is
an extremely valuable tool for educating the public.
Everybody in the CSA who was involved in the making
of this tremendous resource ought to be congratulated.

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Vital Times 2019

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