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the excess prescription opiates fueling addiction and death by over- dose," writes Dr. Gawande. "We have to change that." With that as a backdrop, we asked several physicians about the impact, both positive and negative, the opioid epidemic is having on their efforts to manage post-op pain. "It's encouraged providers to set up clinical pathways that closely examine how much multimodal analgesia can be applied to different procedures in order to minimize the use of opioids," says Daniel Carr, MD, MA, program director of pain, research education and policy at Tufts University School of Medicine in Boston, Mass. "On the other hand, the stigma of opioid use can keep the effective pain therapy from innocent surgical patients who could truly benefit from it." A positive development from the opioid epidemic, our experts say, is that more and more surgeons are prescribing the "minimum quanti- ty necessary," writing for 15 opioid pills rather than 50 after a lap chole or inguinal hernia, for example. The benefits of adjusting dis- charge prescriptions to be more consistent with the number of pills patients actually need are twofold. There's less chance of the patient becoming dependent and of unused pills getting diverted. "Surgeons give patients prescriptions for opioids, and a fair amount of those medications can go unused, which contributes to the opioid epidemic," says Christopher Wu, MD, a professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Md. The opioid epidemic has created another reality surgical facilities must face: Chronic opioid users often need higher-than-expected doses to get adequate analgesia, which can be surprising to care- givers, says Roger Chou, MD, professor of medicine at Oregon Health and Science University in Portland and co-author of the American A P R I L 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 2 1