Improving opioid stewardship programs through shared decision-making.

Opioid stewardship has emerged as an innovative systems-level approach designed to reduce inappropriate opioid prescriptions and improve patient safety in acute care settings. Modeled on the successes of antimicrobial stewardship programs, key distinctions exist; in particular, the inherent subjectivity of managing acute pain is an important consideration of opioid stewardship that differentiates it with the more objective features of antibiotic selection. Shared decision-making, with pharmacists playing a central role, is regarded as an integral part of patient care and plays a vital role in managing pain. We describe important attributes of opioid stewardship and highlight the value of incorporating shared decision-making into these novel programs.