Features  |   November 2018
The Ethics of the Opioid Epidemic: How We Got Here, and Where to Go From Here
Author Affiliations
  • Krishnan S. Ramanujan, M.D.
    Committee on Ethics
  • Jeffrey S. Jacobs, M.D., M.B.A, FASA
    Committee on Ethics
Article Information
Ethics / Medicolegal Issues / Features / Opioid
Features   |   November 2018
The Ethics of the Opioid Epidemic: How We Got Here, and Where to Go From Here
ASA Monitor 11 2018, Vol.82, 16-18.
ASA Monitor 11 2018, Vol.82, 16-18.
The opioid epidemic is one of the largest and most recent public health crises to strike the United States, with the rate of opioid-related overdose deaths nearly quadrupling between 1999 and 2014. To combat this growing epidemic, research has been conducted to identify those at highest risk of death secondary to opioid overdose.1  Various public health policies have been implemented to prevent and treat opioid misuse and abuse.2,3  Such efforts have resulted in an 8.1 percent nationwide reduction in annual prescribing rate per 100 persons of all opioids and a 46.8 percent reduction in annual prescribing rate per 100 persons of high-dose opioids, defined as ≥90 morphine milligram equivalents per day. Despite these positive trends, rates of drug overdose deaths have continued to increase in recent years, with the rate of overdose deaths involving any opioid increasing by 15 percent annually between 2013 and 20154 . These harrowing statistics, combined with the fact that anesthesiologists and pain management specialists account for 5 percent of opioid prescriptions nationwide and often introduce patients to opioids for the first time in the perioperative period,5  demonstrate the increasing importance of critically analyzing current opioid prescription practices and identifying an ethical way to not only manage pain but also curb the opioid epidemic.
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