Since the CDC declared a public health emergency over the opioid epidemic in 2017, an alarming increase in opioid overdose due to prescription opioids has emerged. The CDC has reported that death rates caused by synthetic opioids have risen by almost 26% in the past year. We’ve spotted the problem, but this is only the beginning. Now is the time to make a change that starts with you.
Uncontrolled and indiscriminate prescribing of opioids has led to an opioid crisis that started in North America and has spread throughout high-income countries. The aim of this narrative review was to explore some of the current issues surrounding the use of opioids that includes fentanyl in the perioperative period, focusing on drivers that led to escalation of use, patient harms, the move away from using self-reported pain scores alone to assess adequacy of analgesia, concerns about the routine use of controlled-release opioids for the management of acute pain, opioid-free anesthesia and analgesia, and prescription of opioids on discharge from hospital. Not since I left the hospital after cancer surgery have I received a call following my progress and following my dependent use of opioid pain medicine.
According to the JAMA study, much opioid overprescribing has been caused by a lack of understanding of the difference between acute pain, an appropriate response to tissue damage and for which opioids remain an effective and important component in its management, and chronic non-cancer pain, which represents a dysfunctional pain system and for which opioids are not recommended. In each such instance the prescribed use of opioids including fentanyl and the patients expectation by the prescribing physician to end their use is seriously missing. NBMT was founded as a result of a personal mission to end prescribed fentanyl and other opioid addiction through a non-medication based approach. The development of the Brereton Barrier™ reflects the needed understanding of the intersections of the mechanisms in underlying opioid addiction, prescription drugs, and wellness devices, where patient health outcomes are greatly needed. This understanding adds a distinctive quality to the development of the Brereton Barrier™ as it reflects patient understanding and empowerment of a simple, safe, driven solution.
Our final thoughts
The JAMA describes the origins of the opioid crisis as multifactorial and includes good intentions to keep patients pain free in the postoperative period. Assessment of patient function may be better than unidimensional numerical pain scores to help guide postoperative analgesia. Immediate-release opioids can be titrated more easily to match analgesic requirements. Attention should be paid to discharge opioid prescribing as repeat and refill prescriptions are risk-factors for persistent postoperative opioid use and future misuse and addiction. Opioid stewardship and non-medication based tapering and curing addiction are paramount. Many governments are passing legislation, while statutory bodies and professional societies are providing only advice and guidance, without a safe, easy to control solution to provide limited help in mitigating the harm caused by opioids and the patients addiction and use abuses.
Opioids will remain a crucial part of many patients’ journey from surgery to full recovery. Fentanyl, the most powerful of opioid pain medications remains high on the prescribe list. What remained missing was a safe and patient controlled process for tapering off the highly addictive medication, until the Brereton Barrier™. The last few decades have shown that unfettered opioid use puts patients and societies at risk, so more than simply caution is needed to mitigate those dangers. Through the invention and introduction of the Brereton Barrier™ society now has a safe patient driven solution where before they were limited to cautions of prevention and limits of treatment. While opioid and fentanyl stewardship provides a multilayered structure to allow continued safe use of opioids as part of broad pain management strategies for those patients who benefit from them most, there leaves open the opportunity for the medication free Brereton Barrier™ empowering solution system and process to bring balance to societies needs and reduce the addiction epidemic.