Mitigating Opioid Dependence in Orthopaedic Surgery: Current Strategies and Future Directions.

The opioid crisis presents a significant burden to patients and healthcare systems. Orthopaedic surgery involves treating patients with significant pain demands, therefore opioid stewardship in this specialty is an important area in targeting the opioid crisis. A number of strategies have been outlined in the literature to help reduce prescription of opioids for patients with painful orthopaedic conditions. Enhanced recovery after surgery (ERAS) protocols involving multimodal analgesia (MMA) and multi-disciplinary team (MDT) involvement have been proven effective. Pre-operative counselling of patients with clear communication and educational resources helps to educate patients on the negative effects overuse of opioids can have post-operatively. Novel strategies are being investigated to reduce opioid dependence, particularly in the areas of artificial intelligence (AI) and machine learning (ML), which can help predict patients at increased risk of opioid dependence post-operatively and therefore provide personalised treatment to prevent the harmful sequelae.