Caring for Patients with Substance Use Disorders in the Perioperative Space-CME Paid Option-Caring for Patients with Substance Use Disorders in the Perioperative Space (720p HD)

Video Transcription

Video Summary

This Lunch and Learn focuses on caring for patients with substance use disorders (SUD) in the perioperative setting. Presenter Rachel Duncan, a pharmacist consultant and opioid stewardship expert, explains that SUD is a chronic, treatable disease defined by consequences and behaviors (not simply tolerance or withdrawal), and emphasizes distinguishing physical dependence from SUD.<br /><br />A 2023 study of elective surgery patients found “unhealthy substance use” in up to 2 in 5 patients, highlighting the need for routine screening. Substance use is linked to poorer surgical outcomes (e.g., tobacco and wound complications, heavy alcohol and mortality, cocaine and anesthesia risks, opioids and respiratory depression/pain control challenges, and emerging cannabis considerations).<br /><br />Key recommendations include using validated screening tools (e.g., TAPS, AUDIT-C, DAST-10), asking non-stigmatizing, assumption-based questions to reduce underreporting, and assessing withdrawal risk by asking patients about prior withdrawal experiences. Intra- and postoperative management should emphasize multimodal, non-opioid analgesia, regional/neuraxial techniques, close monitoring for withdrawal, and early involvement of pain/addiction specialists.<br /><br />Ethical/legal topics include shared decision-making, equity, confidentiality (HIPAA/42 CFR), informed consent for toxicology, and trauma-informed, person-first language. Case examples cover perioperative buprenorphine (often continue/split dosing; plan for rescue analgesia) and heavy alcohol use (AUDIT-C, CIWA protocols, careful opioid prescribing, naloxone).

Keywords

perioperative substance use disorder care

opioid stewardship

validated screening tools (TAPS, AUDIT-C, DAST-10)

multimodal non-opioid analgesia

buprenorphine perioperative management

withdrawal risk assessment and monitoring

trauma-informed person-first language

HIPAA and 42 CFR confidentiality