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Invited Commentary
October 2018

A Learning Health System Approach to the Opioid Crisis: Never Let a Good Crisis Go to Waste

Author Affiliations
  • 1Surgery, University of California, San Francisco
  • 2Medicine, University of California, San Francisco
  • 3Health, University of California, San Francisco
JAMA Surg. 2018;153(10):954. doi:10.1001/jamasurg.2018.2731

The opioid crisis is in the national headlines almost daily. Many US states have enacted prescribing restrictions and stipulations to begin addressing the problem. While it is unclear how much of the excess supply of opioids in circulation stems from perioperative prescribing, significant variation in prescribing practices is clear.1,2 We would argue that if practicing surgeons reflected on their own opioid prescribing practices, they would likely identify areas to improve. However, they would also realize the limited resources to appropriately set patient expectations for postprocedure pain and the paucity of evidence available to support approaches to calculating the dose and duration of opioids needed after common surgical procedures or the use of nonopioid analgesic regimens. In this issue of JAMA Surgery, Wetzel et al3 present a systematic review of interventions for postsurgical opioid prescribing, with a focus on system-level interventions, such as practice guidelines and electronic health record modifications. The authors conclude the same thing that many of us have come to realize in our daily practice: that there is evidence that these approaches are effective, but the literature in this area is very limited.

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