Perioperative Care for Patients with Opioid Use Disorder-Recording - Perioperative Care for Patients with Opioid Use Disorder

Video Transcription

Video Summary

Dr. Jan Weiderman, a pediatrician and addiction medicine specialist, argues that substance use disorder is a major medical disease that is often misunderstood by physicians. He emphasizes that it is not a choice, is strongly influenced by genetics, and frequently overlaps with other medical conditions. His talk focuses on perioperative care for patients with opioid use disorder, especially those taking buprenorphine, methadone, or naltrexone.<br /><br />He explains that buprenorphine is highly effective for both opioid use disorder and pain control, and that many clinicians incorrectly stop it before surgery. Based on his experience and recent studies, he recommends continuing buprenorphine through surgery, often splitting the dose every 6–8 hours for pain relief and adding full agonist opioids only if needed. He notes that stopping buprenorphine can increase pain, withdrawal, and even postoperative risk. He also discusses extended-release buprenorphine (Sublocade), methadone coordination with treatment clinics, and the challenges of restarting naltrexone after surgery.<br /><br />Throughout the talk, he shares clinical stories showing how patients did better when buprenorphine was maintained. He criticizes the lack of education among surgeons, pharmacists, and academic centers, and calls for better communication and planning before surgery. He also highlights emerging non-opioid pain treatments and warns against oversimplified solutions like fentanyl vaccines.<br /><br />His overall message is that better medical knowledge, earlier recognition of opioid use disorder, and more thoughtful perioperative planning can improve pain control, reduce harm, and help address the addiction epidemic.

Keywords

opioid use disorder

buprenorphine

perioperative care

methadone

naltrexone

substance use disorder

addiction medicine

postoperative pain

pain management

opioid treatment