{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:48Z","timestamp":1783509288982,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:p>Podiatric physicians have come to realize that opioid use disorder (OUD) is a public health crisis causing morbidity, mortality, lost productivity, and legal cost in the United States. Opioid analgesics are efficient first-line pain relievers for acute and chronic lower-extremity pain syndrome. Perioperative pain management strategies have been proposed using opioid stewardship, but there are few standardized protocols to guide podiatric medical providers treating patients with OUD. First, we describe the pharmacology of therapeutic agents used as medications for addiction treatment for OUD and substance use disorder (SUD). Second, we offer criteria for selecting acute pain and perioperative management in patients with OUD and SUD per current medical literature. Finally, we review the literature applying opioid stewardship in the context of prescribing opioid analgesics in the presence of OUD and SUD.<\/jats:p>\n                  <jats:p>Three hypothetical clinical scenarios grounded in clinical-based literature are described with congruent data and founded guidelines. The first and second scenarios describe acute pain and perioperative management in patients with OUD receiving methadone and buprenorphine-naloxone, respectively. The third scenario describes acute pain and perioperative management in a patient with SUD receiving intravenous naltrexone. We hope that the lower-extremity specialist will appreciate that thoughtful management of acute perioperative pain among patients who receive medications for addiction treatment for OUD is critically important given the risks of destabilization during the perioperative period. The literature reveals the lack of rigorous evidence on acute pain management in patients who receive medication for OUD; however, some clinical evidence supports the practice of continuing methadone or buprenorphine for most patients during acute pain episodes.<\/jats:p>","DOI":"10.7547\/22-150","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T13:48:57Z","timestamp":1689601737000},"source":"Crossref","is-referenced-by-count":1,"title":["An Appraisal of Using Opioids in Patients with Opioid Use Disorder"],"prefix":"10.3390","volume":"113","author":[{"given":"Robert G.","family":"Smith","sequence":"first","affiliation":[{"name":"STOP-Studying Opioid Harm 501.3c, 723 Lucerne Cir, Ormond Beach, FL 32174."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"JAMA Psychiatry","first-page":"767","article-title":"Cost-effectiveness of treatments for opioid use disorder","volume":"78","author":"Fairley M","year":"2021","unstructured":"Fairley M, Humphreys K, Joyce VR, : Cost-effectiveness of treatments for opioid use disorder. JAMA Psychiatry 78: 767, 2021."},{"key":"B2","series-title":"Med Care","first-page":"901","article-title":"The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013","volume":"54","author":"Florence CS","year":"2016","unstructured":"Florence CS, Zhou C, Luo F, : The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 54: 901, 2016."},{"key":"B3","series-title":"JAMA","first-page":"1444","article-title":"The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states","volume":"319","author":"Mokdad AH","year":"2018","unstructured":"Mokdad AH, Ballestros K, Echko M, ; US Burden of Disease Collaborators. The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states. JAMA 319: 1444, 2018."},{"key":"B4","article-title":"National survey on drug use and health 2018 (NSDUH-2018-DS0001)","unstructured":"Substance Abuse and Mental Health Data Archive: National survey on drug use and health 2018 (NSDUH-2018-DS0001). Available at: https:\/\/www.datafiles.samhsa.gov\/study-dataset\/national-survey-drug-use-and-health-2018-nsduh-2018-ds0001-nid18758. Accessed June 20, 2022."},{"key":"B5","series-title":"Wounds","first-page":"146","article-title":"Mitigating the opioid crisis for wound care providers using opioid stewardship","volume":"32","author":"Smith RG","year":"2020","unstructured":"Smith RG: Mitigating the opioid crisis for wound care providers using opioid stewardship. Wounds 32: 146, 2020."},{"key":"B6","series-title":"Foot (Edinb)","first-page":"101708","article-title":"Mitigating the opioid crisis for the lower extremity provider opioid stewardship programs","volume":"45","author":"Smith RG","year":"2020","unstructured":"Smith RG: Mitigating the opioid crisis for the lower extremity provider opioid stewardship programs. Foot (Edinb) 45: 101708, 2020."},{"key":"B7","series-title":"Podiatry Management","first-page":"105","article-title":"Mitigating the opioid crisis for the podiatric physician: remembering the morphine acronym","volume":"39","author":"Smith RG","year":"2020","unstructured":"Smith RG: Mitigating the opioid crisis for the podiatric physician: remembering the morphine acronym. Podiatry Management 39: 105, 2020."},{"key":"B8","series-title":"Anesth Analg","first-page":"539","article-title":"Opioid use disorders: perioperative management of a special population","volume":"127","author":"Ward EN","year":"2018","unstructured":"Ward EN, Quaye AN, Wilens TE: Opioid use disorders: perioperative management of a special population. Anesth Analg 127: 539, 2018."},{"key":"B9","series-title":"J Bioeth Inq","first-page":"275","article-title":"Stigma and self-stigma in addiction","volume":"14","author":"Matthews S","year":"2017","unstructured":"Matthews S, Dwyer R, Snoek A: Stigma and self-stigma in addiction. J Bioeth Inq 14: 275, 2017."},{"key":"B10","series-title":"Drug Alcohol Depend","first-page":"139","article-title":"Pain intolerance in opioid-maintained former opiate addicts: effect of long-acting maintenance agent","volume":"63","author":"Compton P","year":"2001","unstructured":"Compton P, Charuvastra VC, Ling W: Pain intolerance in opioid-maintained former opiate addicts: effect of long-acting maintenance agent. Drug Alcohol Depend 63: 139, 2001."},{"key":"B11","series-title":"Drug Alcohol Depend","first-page":"143","article-title":"Co-morbid pain and opioid addiction: long term effect of opioid maintenance on acute pain","volume":"145","author":"Wachholtz A","year":"2014","unstructured":"Wachholtz A, Gonzalez G: Co-morbid pain and opioid addiction: long term effect of opioid maintenance on acute pain. 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