It’s Substance Abuse Prevention Month. In the OR, Prevention Starts Before the First Incision

October is National Substance Use Prevention Month. It is a reminder that prevention doesn’t just happen in clinics or community programs. It can start with the perioperative team and anesthesia professionals in the pre-op clinic, the OR, and the PACU, where every conversation about pain and recovery can shape a patient’s path forward. (SAMHSA)

In a 2022 “Second Opinions” column for MedPage Today, I argued that surgical pain management must be both compassionate and evidence-based—pairing right-sized opioid use with multimodal, non-opioid strategies and clear patient communication. That message is even more urgent today as we translate national progress into sustainable perioperative practice.

The picture in 2025: progress, with important cautions

• Overdose deaths finally fell: CDC provisional data estimate 107,543 overdose deaths in 2023 (–3% vs. 2022) and projected a further national decrease of ~27% in 2024 (to ~80,391). That’s hopeful—but uneven across states and communities. (CDC)
• Substance use remains prevalent: In 2023, 2.0% (≈5.7M) of Americans 12+ met criteria for opioid use disorder (OUD); 1.9% (≈5.3M) had a prescription pain reliever use disorder. Young adults still carry a high overall Substance Use Disorder (SUD) burden. msms.org)

What this means for perioperative teams: Prevention Month is the perfect time to tighten our opioid stewardship and standardize multimodal pathways—so fewer patients transition from acute, legitimate use to long-term harm.

Four practical moves every surgical service can make now

1. 1. Normalize shared decision-making in pre-op. Set expectations around functional recovery, not zero pain. Use plain language on when opioids help, when they don’t, and the importance of working with their surgeon to taper use. The 2022 CDC guideline update explicitly moved away from rigid dose/day limits, emphasizing individualized care and careful tapering support (CDC). Also, ensure patients on medications for opioid use disorder (MOUD)—like buprenorphine (Suboxone) or methadone—have clear perioperative continuation plans to avoid withdrawal and prevent relapse.
2. 2. Identify opioid use risk early—even in ASC settings. Use validated screening tools (e.g., ORT, COMM) and EMR-based alerts to flag patients at high risk of misuse, relapse, or untreated OUD. Early identification allows perioperative teams to tailor pain strategies, involve addiction specialists when needed, and avoid one-size-fits-all approaches—no matter the care setting.
3. 3. Default to multimodal, opioid-sparing regimens. Develop and implement the use of regional or neuraxial anesthesia and ERAS protocols wherever appropriate. Encourage scheduled acetaminophen and NSAIDs when safe and add gabapentinoids selectively. Large-scale studies and perioperative consensus guidelines continue to support minimizing high-dose opioids and maximizing non-opioid strategies to improve outcomes and reduce persistent opioid use.(thepoqi.org)
4. 4. Right-size discharge scripts. Partner with surgeons and hospitals to align discharge opioid prescriptions with procedure type and patient-specific factors (like opioid-naïveté), using EHR defaults and smart phrases to reduce variability. Pair every script with a written taper plan—and ensure no patient is sent home without a strategy for managing pain, function, and safe recovery.(Michigan Health)

Desirée Chappell is Vice President of Clinical Quality at NorthStar Anesthesia, Co–Editor in Chief and Lead Anchor for TopMedTalk, and serves on the Anesthesia Patient Safety Foundation Board of Directors. (Anesthesia Patient Safety Foundation)