Position Statement

Opioid Prescribing by Foot and Ankle Surgeons

Approved by the Board of Directors July 2022

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The Center for Disease Control and Prevention (CDC) (2018) reports a fivefold increase in opioid deaths since 1999. In addition, the CDC reported (2018) 115 patient deaths daily from opioid overdose in the year 2016. Opioid prescribing has dramatically increased since the 1990s. Both prescription and non- prescription opioid usage has resulted in an opioid crisis in America. Opioid overdose is the leading cause of accidental deaths in young adults, associated with a higher risk of postoperative death, and increases the risk of fall and fractures.

American College of Foot and Ankle Surgeons (ACFAS) members subscribe to the highest ethical, professional, and legal standards and recognize that patients need to have access to appropriate pain relief. ACFAS and its members also recognize the importance of working towards a solution to the opioid crisis.

Opioids are often indicated for the treatment of severe short-lived pain during acute events such as trauma or surgery. Although opioids can be highly addictive, opioid addiction rarely emerges when opioids are used for short-term treatment of pain, except among a few highly susceptible individuals. For the foot and ankle surgeon, the usage of opioids in the acute setting encompasses the vast majority of prescribing. Despite this stated value of opioids, the role of opioids in the treatment of chronic pain has come under scrutiny. Recent open-ended and indiscriminate long-term prescribing of opioids in the United States has led to high rates of prescription opioid misuse and abuse, unacceptable death rates, and an enormous burden to the public. Chronic pain treatment strategies that focus on improving long- term quality of life should include consideration of a referral to a pain management specialist by the foot and ankle surgeon.

Standardized Opioid Protocols for the Foot and Ankle Surgeon

These recommendations are for the benefit of the patient. Foot and ankle surgeons should develop protocols and procedures that should include consideration of:
  • Individual state guidelines where available.
  • Guidelines for the acute pain patient suffering from trauma.
  • Guidelines for the acute pain following surgery.
  • Identification of patients at high risk for opioid addiction, substance use disorder, or an opioid- related adverse drug event.
  • References related to opioid use and alternative pain management solutions.
  • Establishing ranges for acceptable amounts and durations for patients during their post- operative period.
  • Utilizing a pain management specialist when appropriate.
  • Restricting the usage of opioids beyond the immediate postoperative period.
  • Restricting the usage of extended release opioids as most patients are treated for acute pain.
  • Limiting opioid prescription size established by your set ranges and acceptable amounts
ACFAS strongly advocates continued research, organizational collaborations, adoption of best practices in opioid prescribing, identify ways to minimize opioid risk and find effective alternatives to opioids for the treatment of various pain problems. ACFAS encourages members to refer to federal and state resources for the latest guidelines.

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The American College of Foot and Ankle Surgeons is a professional society of more than 8,000 foot and ankle surgeons. Founded in 1942, the College’s mission is to promote research and provide continuing education for the foot and ankle surgical specialty, and to educate the general public on foot health and conditions of the foot and ankle through its patient education website, FootHealthFacts.org.