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Bone Bulletin

Abstract

Background

The opioid epidemic has emerged as one of the most pressing public health challenges of our time, marked by significant increases in opioid-related dependence, abuse, and death in recent years. Excess prescription of opioids represents a major contributing factor to this crisis.1 The origins and impact of the opioid epidemic in the United States are documented in Sam Quinones research narrative, Dreamland. He highlights how pharmaceutical companies leveraged misinterpreted research—particularly a 1980 letter published in The New England Journal of Medicine suggesting a low risk of addiction associated with opioids—to normalize their widespread prescription. This flawed evidence served as the basis for marketing campaigns that falsely portrayed opioids as safe and effective for chronic pain management, leading to a significant escalation of the opioid crisis. Quinones also discusses how the adoption of "pain as the fifth vital sign" shifted healthcare priorities, prompting physicians to treat pain more aggressively and contributing to the epidemic.2 Driven by the widespread availability and overprescription of pain medications, this crisis has highlighted the urgent need for safer and more effective approaches to pain management across medical disciplines.

Orthopedic surgeons face the challenge of managing pain effectively while minimizing the risks associated with opioid use. As a field with significant postoperative pain management needs, orthopedics has become a key contributor to the opioid crisis. For instance, a large prospective evaluation of postoperative opioid consumption following upper-extremity surgical procedures over six months revealed that patients were prescribed approximately three times more opioids than they needed.3 This overprescription often leads to diversion, where unused opioids are redirected for non-medical use, increasing the risk of misuse and contributing to the opioid epidemic.3 To address these challenges, strategies such as preoperative counseling, multimodal pain management, Enhanced Recovery After Surgery (ERAS) protocols, and the exploration of medical cannabis have emerged as promising solutions to reduce opioid reliance and improve patient outcomes.

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