Opioid Use in Urologic Practice

Purpose of Review The opioid epidemic has become a major public health crisis over the last two decades. The opioid-related deaths and economic costs have increased dramatically since opioid analgesics started to be prescribed regularly to help control cancer- and non-cancer-related pain in the late twentieth century. As a result of the worsening opioid crisis, various guidelines and government regulations have recently been implemented to cope with this opioid problem as it affects all fields of medicine, urology included. Many conditions in urology involve chronic pain medication, including neurogenic bladder. This review seeks to summarize the growing problem of opioid use and prescribing practices nationwide. Recent Findings Specifically to urology, there is a growing body of literature that could aid urologists in creating good practices and guidelines to improve safety for patients requiring narcotic medications to increase awareness of new legal requirements and utilization of multimodal and alternative therapies post-operative, acute pain as well as chronic pain. The CDC has published 12 guidelines that have been used to frame state-specific chronic opioid prescribing guidelines and laws nationwide. Moreover, many states have enacted laws regulating the use of opioids and in some cases penalizing physicians for non-compliance. Specific to urology, studies have demonstrated unfilled opioid prescriptions after urologic procedures, considerable variability in the prescribing habits, and low rates of opioid dependency after prescription for acute post-operative pain. Urologists and all physicians are increasingly under the microscope for opioid prescribing practices and need to understand current guidelines and literature.