I had the honor of being a keynote lecturer at the 2021 Association of Anaesthetists Winter Scientific Meeting. For this talk, I provided some historical background on various contributing factors to the U.S. opioid epidemic, the current state including the many legislative and regulatory responses, and potential opportunities to innovate in clinical care moving forward.

1. @EMARIANOMD
Lessons learned from the
U.S. opioid epidemic
Edward R. Mariano, M.D., M.A.S.
Professor of Anesthesiology, Perioperative & Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology and Perioperative Care
Veterans Affairs Palo Alto Health Care System

2. @EMARIANOMD
Overview
• How did this happen?
• Where are we now?
• What do we do to move forward?

3. @EMARIANOMD
Overview
• How did this happen?
• Where are we now?
• What do we do to move forward?

4. @EMARIANOMD

5. @EMARIANOMD
The Opioid Epidemic
https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0
https://www.cdc.gov/drugoverdose/epidemic/index.html

6. @EMARIANOMD
The Opioid Epidemic
https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0
https://www.cdc.gov/drugoverdose/epidemic/index.html

7. @EMARIANOMD
Brummett, et al. JAMA 2017
Klueh, et al. JGIM 2018
The Role of Surgery

8. @EMARIANOMD
Updates
Coming Soon!
“Acute pain can often
be managed without
opioids…. More than
7 days will rarely be
needed.”

9. @EMARIANOMD
https://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx

10. @EMARIANOMD
Overview
• How did this happen?
• Where are we now?
• What do we do to move forward?

11. @EMARIANOMD
Mudumbai & Mariano, et al. Pain Med 2016
The Opioid Epidemic

12. @EMARIANOMD
The Opioid Epidemic
https://www.cdc.gov/drugoverdose/epidemic/index.html

13. @EMARIANOMD
The Opioid Epidemic
Mudumbai & Mariano, et al. Pain Med 2016

14. @EMARIANOMD
Unintended Consequences

15. @EMARIANOMD

16. @EMARIANOMD
Elkassabany & Mariano. Anaesthesia 2019

17. @EMARIANOMD
Elkassabany & Mariano. Anaesthesia 2019

18. @EMARIANOMD
Opioid-Free Anaesthesia: PRO?
Lavand’homme. EJA 2019

19. @EMARIANOMD
Opioid-Free Anaesthesia: CON
Lirk & Rathmell. EJA 2019

20. @EMARIANOMD
Fiore, et al. BJA 2019

21. @EMARIANOMD
Fiore, et al. BJA 2019

22. @EMARIANOMD
Kharasch, et al. Anesthesiology Feb 2020

23. @EMARIANOMD
Kharasch, et al. Anesthesiology Feb 2020

24. @EMARIANOMD
Overview
• How did this happen?
• Where are we now?
• What do we do to move forward?

25. @EMARIANOMD

26. @EMARIANOMD
Thinking Beyond Blocks
Yajnik, et al. Patient Educ Couns. 2018

27. @EMARIANOMD
Thinking Beyond Blocks
Yajnik, et al. Patient Educ Couns. 2018

28. @EMARIANOMD
Mariano, Schatman. J Pain Res 2019

29. @EMARIANOMD
Elkassabany & Mariano. Anaesthesia 2019
Opioid-Free
Potential

30. @EMARIANOMD
Patient Education is Lacking

31. @EMARIANOMD
Think Beyond the PACU
Mariano, Walters, Kim, Kain. A&A 2015
Walters, Mariano, Clark. Pain Med 2015

32. @EMARIANOMD
Tamboli, Mariano, et al. Pain Med 2019

33. @EMARIANOMD
How Long Does Acute Pain Last?
Mariano, El-Boghdadly, Ilfeld. Anaesthesia 2020

34. @EMARIANOMD
Transitional Pain
Katz, et al. J Pain Res 2015
Huang, et al. Pain Manag 2016

35. @EMARIANOMD
Newer Interventions
Gabriel & Ilfeld. Best Pract 2019

36. @EMARIANOMD
Ilfeld, et al. J Orthop Surg Res 2017

37. @EMARIANOMD

38. @EMARIANOMD
National Leadership Is Required
Elements of Performance for LD.04.03.13
1. The hospital has a leader or leadership team that is responsible
for pain management and safe opioid prescribing and develops
and monitors performance improvement activities.

39. @EMARIANOMD

40. @EMARIANOMD

41. @EMARIANOMD
ASA-Premier Pilot Collaborative

42. @EMARIANOMD
ASA-AAOS Collaboration

43. @EMARIANOMD
Turn Research into Action
2020: Now a National
Quality Metric

44. @EMARIANOMD
Summary
• We discussed lessons learned from the U.S.
opioid epidemic and answered the following
questions:
–How did this happen?
–Where are we now?
–What do we do to move forward?