Table 3. Phases of Perioperative Opioid Use in Terms of OUD.
| Intraoperative | Postoperative Recovery | Inpatient | Outpatient | |
|---|---|---|---|---|
| Likely opioid prescribers | Anesthesiologists and CRNAs | Anesthesiologists, CRNAs, and RNs | Various surgeons, internists, anesthesiologists, pain teams, PAs, RNs | Range of surgeons, interventionists, primary care providers, pain specialists, and PAs |
| Training, experience and heterogeneity of the Prescriber | Routinely prescribe, specific training, and uniform | Routinely prescribe, specific training, and uniform | Variable training and experience, and heterogeneous | Variable training and experience, and highly heterogeneous |
| Concomitantly administered drugs | Hypnotics, sedatives and other adjunct analgesics | Adjunct analgesics, regional and neuraxial anesthesia | Adjunct analgesics, regional and neuraxial anesthesia | Highly variable |
| Level of consciousness | Heavy sedated or unconscious | Possibly sedated and stupors | Unlikely sedated | Generally awake and alert |
| Awareness of opioid euphoric experience | Unlikely | Partial | Intact | Intact |
| Level of pain experienced | Autonomic instability | Significant | Variable | Variable |
| Patient control of opioid use | None | Minimal | Significant | Substantial |
| Administration of opioids | Direct administration by the providers | Direct administration by the providers | Given under close supervision | Consumed by the patients themselves |
| Type of opioids prescribed | Potent, short acting | Potent, short acting | Variable | Variable |
| Route of administration | Intravenous | Generally intravenous | Intravenous, oral | Generally oral, transcutaneous |
| Duration of administration | Finite, short-minutes to hours | Finite, short-minutes to hours | Finite, variable-days | Long, highly variable-days to years |
| Monitoring of patient’s | Extensive-ASA standards | Extensive | Variable but direct | Minimal and indirect |
| Monitoring of patients’ opioid use | Direct | Direct | Variable but direct | Minimal and indirect |
| Primary decision maker of the opioids used | Anesthesia providers | Anesthesia providers | Heterogeneous | Heterogeneous but ultimately patients themselves |
| Potential for OUD | Unknown but unlikely | Unknown but less likely | Unknown | Unknown but likely |
Abbreviations: CRNAs, certified nurse practitioners; OUD, opioid use disorder; Pas, physician assistants; RNs, registered nurses.