What You Need to Know About Opioids

What You Need to Know About Opioids

Opioids are a class of drugs that stimulate the opioid receptors in your brain to block pain signals being sent by your body. Because these receptors are linked to the reward centers in your brain, opioids can also produce a feeling of euphoria.

Some forms of opioids are available legally as medications prescribed by your doctor to treat moderate to severe pain. Other forms of opioids are considered illegal drugs, such as heroin.

Although opioid medications are effective for pain relief, they also come with significant risks. According to the Centers for Disease Control and Prevention (CDC), taking opioids for as little as four days—even when taken as prescribed by your doctor—increases your risk of addiction. Prescription opioids are especially dangerous when taken more often or in a larger quantity than prescribed by your doctor, or when taken without a doctor’s oversight.

Common Side Effects of Opioids

In addition to pain relief and a feeling of euphoria, opioids can produce the following side effects:

  • Slowed breathing, brain activity, and heart rate
  • Lack of appetite and thirst
  • Decreased sexual desire
  • Confusion
  • Drowsiness

Opioid Tolerance, Dependence, and Addiction

If you take opioids for longer than three days, your brain may begin to get used to its opioid receptors being stimulated, which will cause your tolerance to go up. This means you will need a higher dose of the opioid to achieve the same effects. With time, you may become physically dependent on and/or addicted to the opioid, and you will experience withdrawal if you stop taking it. Symptoms of withdrawal, which can begin as soon as four to six hours after the last dose, include:

  • Anxiety and agitation
  • Muscle weakness and cramps
  • Nausea, vomiting, and diarrhea
  • Tremors, chills, and sweating
  • Intense cravings

Because opioids can restrict your ability to breathe (slowing or even stopping your breathing), misuse of opioids can lead to a fatal overdose. That risk is higher if you haven’t taken opioids before or if you are taking other medications or drugs that interact with opioids.

Prescription Opioids Can Be a Gateway to Addiction

There are many entry points for opioid misuse and addiction, with prescription opioids continuing to play a significant role. Research shows that nearly 80% of heroin users report they first misused prescription opioids prior to heroin.1

Although everyone who takes prescription opioids is at risk for addiction, that risk is higher for some people than others. Unfortunately, most people don’t know their risk for addiction before an opioid is prescribed to them.

Risk Factors for Opioid Addiction

There are many known factors associated with increased risk for opioid addiction (also called Opioid Use Disorder, or OUD). They include psychological factors, such as childhood trauma or mental health conditions like anxiety or depression; environmental factors, such as growing up or living in high-stress environments; and biological factors, such as family or personal history of substance abuse.2

To account for these risk factors, your physician will review your medical history, conduct a complete clinical evaluation, and may have you complete a risk questionnaire prior to prescribing opioids to you. It’s important to be as honest and thorough as you can when providing information to your doctor, including disclosing past or present drug use and personal or family history of addiction.

Another key factor is your genetics, which research has shown can account for up to 70% of overall risk for OUD.3 However, until recently, physicians and their patients didn’t have a clinically validated way to assess genetic risk for OUD. But thanks to recent scientific advances, genetic risk assessment is now available.

Know Your Genetic Risk for Opioid Use Disorder

When use of prescription opioids to treat acute pain (pain expected to last <30 days) is being considered, it’s important that you and your doctor understand your genetic risk for opioid addiction before a pain prescription is written.

AvertD™ is a clinically validated test that identifies an individual’s genetic risk for developing OUD. The physician-ordered test requires only a simple cheek swab sample and analyzes 15 genetic markers involved in the brain reward pathways associated with addiction to identify if a patient is at high or low genetic risk for OUD. Having this personalized risk information allows you and your doctor to make more informed decisions about whether the use of prescription opioids to treat acute pain is appropriate for you.

Do you know your genetic risk for opioid addiction? To learn more about AvertD, visit avertdtest.com.

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References

1Heroin DrugFacts. National Institute on Drug Abuse. Available online at: https://nida.nih.gov/publications/drugfacts/heroin

2St Marie B. Assessing Patients’ Risk for Opioid Use Disorder. AACN Adv Crit Care. 2019;30(4):343-352. doi:10.4037/aacnacc2019931

3Bevilacqua L, Goldman D. Genes and addictions. Clin Pharmacol Ther. 2009; 85(4):359–361. doi:10.1038/clpt.2009.6

Could Opioid Addiction Impact You?

Could Opioid Addiction Impact You?

Addiction is a disease, not a choice, and it can happen to any of us. While there are many factors that contribute to addiction, we know that prescription opioids―even when taken as prescribed―can be a gateway to misuse and addiction.

For some people, their first exposure to opioids is when they receive a prescription from their doctor to treat acute pain―pain expected to last <30 days―following surgery or an injury. Unfortunately, most people don’t know their risk for addiction before an opioid is prescribed to them. Take Mike for example, who shared his story on the Centers for Disease Control and Prevention (CDC) website.

During his senior year of high school, Mike had surgery to repair a broken wrist from playing hockey. Following his surgery, he was prescribed opioids by his doctor. Shortly after, his wisdom teeth were removed, and he was given another prescription for opioids by his dentist.

Within three to six months of first taking prescription opioids, Mike’s use of prescription opioids had escalated to addiction.

“I was given a prescription opioid pain medication that lasted a lot longer than the pain itself,” says Mike. “At the time, I didn’t understand the dangers of these drugs and within only a few months, I was completely addicted. I lost everything. I had to leave school and stop playing sports in college. I started to watch my life slip away. These drugs are addictive. One prescription can be all it takes to lose everything.”

If Mike had better understood his risk for addiction prior to being prescribed opioids, his experience may have been different.

Another example is Rebekkah, who shared her story on TheTruth.com. When she was 14, she blew out her ankle during cheerleading practice and was prescribed opioid pills. However, instead of getting better, she quickly found herself addicted to the opioids and eventually turned to heroin. She’s not alone: 80% of heroin users started with a prescription painkiller.

Rebekkah had been an accomplished dancer and athlete, and that was lost when her addiction took over her life and self-image.

Opioid addiction is a disease that doesn’t discriminate. Anyone who takes prescription opioids is at risk for addiction, but for some people, that risk is higher than others.

AvertD is a clinically validated genetic test that identifies your genetic risk for developing opioid addiction, also known as Opioid Use Disorder (OUD). Having this personalized risk information allows you and your doctor to make more informed decisions about whether the use of prescription oral opioids to treat acute pain is appropriate for you.

Do you know your risk for opioid addiction? To learn more about AvertD, visit avertdtest.com.

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Help Stop the Stigma & Shame Around Addiction

Help Stop the Stigma & Shame Around Addiction

For people who are struggling with a substance use disorder, one of the biggest barriers to getting the treatment and support they need is the stigma associated with addiction.

According to a 2016 report from the Surgeon General, nearly 21.2 million Americans have a substance use disorder, but only 10% are receiving treatment for it.1 In addition, more than 40% of people with a substance use disorder also have a mental health condition, but less than half (48%) are receiving treatment for either.2

Many people who could benefit from treatment and other resources do not utilize them because of the shame and blame associated with addiction. However, it’s important to understand that addiction is not a choice, a sign of weakness, or a moral failing; it is a disease that requires treatment. Unfortunately, the shame and stigma associated with addiction often prevents people from getting the help and resources they need to recover.

As with other diseases that are treatable and often preventable, addiction disrupts the normal functioning of an organ (in this case, the brain) and causes serious harm. According to brain imaging studies of people with addiction, this serious harm includes physical changes to the brain in areas that are important when it comes to judgment, decision-making, learning and memory, and controlling behavior.3 These changes make it incredibly hard for someone to stop using an addictive substance, even when they want to.

Just like other diseases and disorders, the likelihood of developing an addiction is different for each person. No single factor determines if you will develop an addiction; however, the more risk factors you have, the greater the chance that use of an addictive substance may lead to misuse and addiction. These risk factors can be environmental (such as growing up in a high-stress environment) or biological (like your genetics).

At SOLVD Health, we recently joined SAFE Project’s national movement to combat stigma by signing the No Shame Pledge, because there’s No Shame in getting help for addiction and mental health. We invite you to join us in combating the negative public perception and supporting others in speaking up about their own disorders.

The No Shame Pledge

  • I understand that addiction is a disease, and I pledge to eliminate the stigma for individuals, family members, and friends experiencing it.
  • I commit to learning more about the disease of addiction and to changing the conversation surrounding it. I support those facing these challenges and want to provide them with a shame-free environment to overcome them.
  • I will learn more about factors that contribute to addictive behavior – such as mental health challenges and trauma – and encourage individuals to seek the help and treatment needed to address them.
  • For individuals in recovery, I pledge to support them in their recovery journey by providing supports, not barriers, as they continue their path of leading a self-directed, safe, productive, and successful life.

Together, we can help spread awareness of and shine a light on stigma to save lives. To learn more about SAFE Project and take the No Shame Pledge, visit https://www.safeproject.us/noshame-mental-health-addiction/

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References:

1Murthy VH. Facing Addiction in the United States: The Surgeon General’s Report of Alcohol, Drugs, and Health. JAMA. 2017;317(2):133–134. doi:10.1001/jama.2016.18215

2Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.

3Fowler JS, Volkow ND, Kassed CA, Chang L. Imaging the addicted human brain. Sci Pract Perspect 3(2):4-16, 2007.

Use of Prescription Opioids to Treat Acute Dental Pain

Use of Prescription Opioids to Treat Acute Dental Pain

After family physicians, dentists are among the top opioid prescribers in the U.S., writing 1 out of every 10 prescriptions for opioids.1,2 These prescribing rates are significantly higher than rates in other countries with similar dental care practices. For example, one study found that dentists in the U.S. prescribe opioids at a rate 70 times higher than dentists in England.3

First Exposure to Opioids for Adolescents

Even more concerning is that dentists are the highest prescribers of opioids to patients 18 years and younger.4 This age group is especially vulnerable, because older adolescents and young adults are at the highest risk for initiation of opioid use, opioid misuse, opioid use disorder (OUD), and death from overdose.5

Research has shown that medical use of prescription opioids is highly correlated with non-medical or illicit use of opioids among high school seniors. Among adolescents who reported both types of use, medical use was generally how it started.6

For many adolescents and young adults, their first exposure to opioids is after wisdom-tooth removal.7 Dentists and oral surgeons remove about 10 million wisdom teeth every year, and 85% of people undergo this procedure during their lifetime.6

Non-Opioid Medications Are Just as Effective

According to the American Dental Association, non-opioid pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen should be considered the first choice for acute pain management.8 However, despite the fact that studies have shown that NSAIDs are as effective as or superior to opioid medications for controlling acute dental pain,9 dentists frequently recommend and prescribe opioids instead of NSAIDs.10,11,12

Particularly concerning is that one study showed that more than half of the opioid prescriptions written by dentists were for longer than the three-day supply recommended by the Centers for Disease Control and Prevention (CDC) for acute dental pain. In addition, 29% of dental patients received more powerful opioids than needed after their dental procedures.8

Know Your Risk for Opioid Use Disorder

Dentists have an ethical and professional obligation to manage their patients’ pain without putting them at unnecessary risk for addiction. Because the risk of addiction is higher for some people than others, it’s important that you and your dentist understand your personal risk for opioid addiction (also called Opioid Use Disorder, or OUD) when use of prescription opioids is being considered.

There are many known factors associated with increased risk for opioid addiction. One important factor is your genetics, which influences whether you are at high or low risk for opioid addiction.13 The good news is that thanks to recent scientific advances, dentists and patients now have a way to assess genetic risk for OUD before a prescription is written.

Make More Informed Decisions About Pain Management

AvertD™ is a clinically validated test that identifies an individual’s genetic risk for developing OUD. The test requires only a simple cheek swab sample and analyzes 15 genetic markers involved in the brain reward pathways associated with addiction to identify if a patient is at high or low risk for OUD.

When use of prescription oral opioids for acute pain is being considered, AvertD offers an objective way to identify who may be at increased genetic risk for opioid addiction—so you and your provider can make more informed decisions about how to manage your pain safely and effectively.

Is your child undergoing a dental procedure soon? Will an opioid be prescribed after the procedure? Do you know your child’s risk is for developing OUD?

If you or someone you love are scheduled for a dental procedure where oral opioids may be prescribed to manage acute pain (pain expected to last <30 days), you should consider taking the AvertD test. Learn more at https://avertdtest.com/for-patients/

Note: Because genetics are only one factor in understanding the risk of developing OUD from using oral opioids, AvertD test results should always be used in conjunction with a complete clinical evaluation to determine the appropriateness of oral opioids for pain management.

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Additional Resources:
References:

1L Rasubala, L Pernapati, X Velasquez, J Burk, YF Ren, Impact of a mandatory prescription drug monitoring program on prescription of opioid analgesics by dentists. PLOS ONE, 10 (8) (2015), Article e0135957. https://doi.org/10.1371/journal.pone.0135957

2ND Volkow, TA McLellan, JH Cotto, M Karithanom, SR Weiss. Characteristics of opioid prescriptions in 2009. JAMA, 305 (13) (2011), pp. 1299-1301 https://doi.org/10.1001/jama.2011.401

3KJ Suda, MJ Durkin, GS Calip, et al. Comparison of opioid prescribing by dentists in the United States and England. JAMA Netw Open, 2 (5) (2019), Article e194303. https://doi.org/10.1001/jamanetworkopen.2019.4303

4Dentists and Opioid Pain Relievers: Why They Prescribe So Many, Especially to Children: https://www.healthline.com/health-news/dentists-and-opioid-pain-relievers-why-they-prescribe-so-many-especially-to-children

5National Institutes of Health HEAL Initiative: https://heal.nih.gov/research/new-strategies/preventing-opioid-use-disorder

6McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015. Pediatrics. 2017;139(4):e20162387. https://doi.org/10.1542/peds.2016-2387. Accessed February 10, 2021.

7Indian Health Service, Division of Oral Health; Indian Health Service, National Committee on Heroin, Opioid and Pain Efforts. Recommendations for management of acute dental pain. Indian Health Service. https://www.ihs.gov/newsroom/ihs-blog/may2019/ihs-introduces-recommendations-for-management-of-acute-dental-pain/. Updated November 2020. Accessed February 10, 2021.

8Suda, K., Zhou, J., Rowan, S., McGregor, J., Perez, R., Evans, C., Gellad, W. and Calip, G., 2020. Overprescribing of Opioids to Adults by Dentists in the U.S., 2011–2015. American Journal of Preventive Medicine, 58(4), pp.473-486.

9Dionne RA, Gordon SM, Moore PA. Prescribing opioid analgesics for acute dental pain: Time to change clinical practices in response to evidence and misperceptions. Compend Contin Educ Dent. 2016;37(6):372-378.

10PA Moore, EV Hersh. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc, 144 (8) (2013), pp. 898-908. https://doi.org/10.14219/jada.archive.2013.0207

11I Mutlu, AO Abubaker, DM Laskin. Narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons after impacted third molar removal. J Oral Maxillofac Surg, 71 (9) (2013), pp. 1500-1503. https://doi.org/10.1016/j.joms.2013.04.031

12JA Baker, J Avorn, R Levin, BT Bateman. Opioid prescribing after surgical extraction of teeth in Medicaid patients, 2000-2010. JAMA, 315 (15) (2016), pp. 1653-1654. https://doi.org/10.1001/jama.2015.19058

13Bevilacqua L, Goldman D. Genes and addictions. Clin Pharmacol Ther. 2009; 85(4):359–361. doi:10.1038/clpt.2009.6

 

Use of Prescription Opioids to Manage Acute Pain after Orthopedic Surgery

Use of Prescription Opioids to Manage Acute Pain after Orthopedic Surgery

For many people, their first exposure to opioids is when they receive an opioid prescription from their doctor to treat acute (short-term) pain following a surgical procedure. An estimated 67 million opioid prescriptions are written each year in the U.S. by surgically-focused specialties.1

Although prescription opioids are effective at treating moderate to severe pain, they also come with a risk of addiction. One study found that 1 in 16 patients become long-term opioid users after surgery.2 Even short-term opioid use can lead to misuse, addiction and, too often, overdose.

Opioid Overprescribing in Orthopedic Surgery

Amongst physicians, orthopedic surgeons are the third-highest prescribers of opioid medications, accounting for nearly 8% of all opioid prescriptions in the United States.3 Orthopedic surgeons specialize in preventing, diagnosing, and treating disorders of the bones, joints, ligaments, tendons, and muscles. They treat a range of conditions, both surgically and non-surgically, including sports injuries and joint replacements like knees and hips.

Each year, approximately 7 million orthopedic surgeries are performed in the United States.4 Safe and effective pain control after these surgeries is critical to restoring the patient’s mobility. However, research has shown that over-prescription of opioids to manage pain after an operation is common in orthopedic surgery.5,6,7

Knee and hip replacements are two of the most common orthopedic surgeries performed annually. One study found that among patients who had never taken opioids prior to their surgery, 8.2% of patients who underwent a knee replacement and 4.3% of patients who underwent a hip replacement were still using opioids 6 months later.8

Know Your Risk for Opioid Use Disorder

Physicians have an ethical and professional obligation to manage their patients’ pain without putting them at increased risk for addiction. Because the risk of addiction is higher for some people than others, it’s important that you and your physician understand your personal risk for opioid addiction (also called Opioid Use Disorder, or OUD) before opioids are ever prescribed.

There are many known factors associated with increased risk for opioid addiction. One important factor is your genetics, which influences whether you are at high or low risk for opioid addiction.9 The good news is that thanks to recent scientific advances, physicians and patients now have a way to assess genetic risk for OUD before a prescription is written.

Make More Informed Decisions About Pain Management

AvertD™ is a clinically validated test that identifies an individual’s genetic risk for developing OUD. The test requires only a simple cheek swab sample and analyzes 15 genetic markers involved in the brain reward pathways associated with addiction to identify if a patient is at high or low risk for OUD.

When use of prescription oral opioids for acute pain is being considered, AvertD offers an objective way to identify who may be at increased genetic risk for opioid addiction—so you and your provider can make more informed decisions about how to manage your pain safely and effectively.

Are you having surgery soon? Will you be prescribed an opioid? Do you know your risk for developing OUD?

If you’re scheduled for a procedure where oral opioids may be prescribed to manage acute pain (pain expected to last <30 days), you should consider taking the AvertD test. Learn more at https://avertdtest.com/for-patients/

Note: Because genetics are only one factor in understanding the risk of developing OUD from using oral opioids, AvertD test results should always be used in conjunction with a complete clinical evaluation to determine the appropriateness of oral opioids for pain management.

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Additional Resources:
References:

1Stark N, Kerr S, Stevens J. Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study. Anaesth Intensive Care. 2017;45(6):700-706. doi:10.1177/0310057X1704500609

2Brummett CM, Waljee JF, Goesling J, et al. New Persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017;152:e170504

3Volkow N.D., McLellan T.A., Cotto J.H., Karithanom M., Weiss S.R.B. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305:1299–1301. doi: 10.1001/jama.2011.401

4Orthopedic Design and Technology. U.S. Healthcare Spending in Orthopedics. https://www.odtmag.com/issues/2019-05-24/view_columns/us-healthcare-spending-in-orthopedics/ Accessed 7/21/21

5Clarke H., Soneji N., Ko D.T., Yun L., Wijeysundera D.N. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348:g1251. doi: 10.1136/bmj.g1251.

6DeFranco M.J., Walch G. Current issues in reverse total shoulder arthroplasty. J Musculoskelet Med. 2011;28:85–94

7Sabatino M.J., Kunkel S.T., Ramkumar D.B., Keeney B.J., Jevsevar D.S. Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Joint Surg Am. 2018;100:180–188. doi: 10.2106/JBJS.17.00672.

8Goesling J, Moser SE, Zaidi B, et al. Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain. 2016;157(6):1259-1265. doi:10.1097/j.pain.0000000000000516)

9Bevilacqua L, Goldman D. Genes and addictions. Clin Pharmacol Ther. 2009; 85(4):359–361. doi:10.1038/clpt.2009.6

Why You (and Your Doctor) Should #KnowYourRisk for Opioid Addiction

Why You (and Your Doctor) Should #KnowYourRisk for Opioid Addiction

Opioids are effective at managing moderate to severe pain and are often prescribed following surgery or injury—but they come with a risk of addiction. While everyone who takes prescription opioids is at risk for addiction, that risk is higher for some people than others.

Because treating acute pain (pain lasting less than 30 days) safely and effectively is a priority for both you and your provider, it’s important to understand your personal risk for addiction before oral opioids like oxycodone and hydrocodone are ever prescribed.

A Gateway to Addiction

While there are many entry points for opioid abuse and addiction, prescription opioids continue to play a significant role, with nearly 80% of heroin users reporting that they first misused prescription opioids prior to heroin.1

Surgical care is one gateway to addiction: An estimated 67 million opioid prescriptions are written each year in the U.S. by surgically-focused specialties,2 potentially leading to as many as 7 million additional Americans misusing or becoming addicted to opioids annually.3

Even short-term opioid use can lead to addiction and, too often, overdose. Research has shown that your odds of still taking opioids a year after starting a short course increases after only five days of taking them.4 Another study found that each year, 6% of patients prescribed oral opioids for post-surgical pain were still taking opioids three to six months after surgery.5

And the consequences of opioid addiction are dire: In 2020, more than 93,000 people died from drug overdoses—the highest number of overdose deaths ever recorded—and almost 75% of these deaths were opioid-related.6

Risk Factors for Opioid Use Disorder

There are many known factors associated with increased risk for opioid addiction (also called Opioid Use Disorder, or OUD). They include psychological factors, such as childhood trauma or mental health conditions like anxiety or depression; environmental factors, such as growing up or living in high-stress environments; and biological factors, such as family or personal history of substance abuse.7

To account for these factors, your physician will review your medical history, conduct a complete clinical evaluation, and may have you complete a risk questionnaire. It’s important to be as honest and thorough as you can when providing information to your doctor.

Another key factor is your genetics, which research has shown can account for up to 70% of overall risk.8 However, until recently, physicians and their patients didn’t have an objective way to assess genetic risk for OUD. But thanks to recent scientific advances, genetic risk assessment is now available.

Designed for More Informed Decisions

AvertD is a clinically validated test that identifies an individual’s genetic risk for developing OUD. The test requires only a simple cheek swab sample and analyzes 15 genetic markers involved in the brain reward pathways associated with addiction to identify if a patient is at high or low risk for OUD.

When use of prescription oral opioids for acute pain is being considered, AvertD offers an objective way to identify who may be at increased genetic risk for opioid addiction—so you and your provider can make more informed clinical decisions about how to manage your pain safely and effectively.

Because genetics are only one factor in understanding the risk of developing OUD from using oral opioids, AvertD test results should always be used in conjunction with a complete clinical evaluation to determine the appropriateness of oral opioids for pain management.

Want to #KnowYourRisk? Learn more at https://avertdtest.com/

References:

1Opioid Overdose Crisis. National Institute on Drug Abuse. Available online at: https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

2Stark N, Kerr S, Stevens J. Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study. Anaesth Intensive Care. 2017;45(6):700-706. doi:10.1177/0310057X1704500609

3Guy G, Zhang K. Opioid prescribing by specialty and volume in the US. Am J Prev Med. 2018; 55(5):e153-e155

4How opioid addiction occurs. Mayo Clinic. Available online at https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372

5Brummett, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504.

6Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2021. Accessed at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm on July 26, 2021.

7St Marie B. Assessing Patients’ Risk for Opioid Use Disorder. AACN Adv Crit Care. 2019;30(4):343-352. doi:10.4037/aacnacc2019931

8Bevilacqua L, Goldman D. Genes and addictions. Clin Pharmacol Ther. 2009; 85(4):359–361. doi:10.1038/clpt.2009.6