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KEY POINTS

KEY POINTS

  • Because excessive alcohol consumption and/or opioid pain reliever abuse are frequently observed in injured patients, trauma surgeons should know the common substances abused and the interventions to help the patient.

  • An estimated 16 million people in the United States have alcohol use disorder, and an estimated 623,000 of them are adolescents.

  • American College of Surgeons Levels I and II trauma centers are mandated to have protocols in place to assess and screen patients who are at risk for alcohol use disorder.

  • Prescription opioid overdoses and a recent surge in illicit opioid overdoses (heroin and illegally made fentanyl) are interconnected trends that have fueled America’s opioid overdose epidemic.

  • Most illicit drugs exert their initial reinforcing effects by activating reward circuits in the brain similar to those involved in alcohol addiction. Continued drug use impairs brain function by interfering with the capacity to exert self-control over drug-taking behaviors.

  • Treatment for opioid use disorder includes the following medications: methadone, a synthetic opioid agonist that eliminates withdrawal symptoms and relieves drug cravings; buprenorphine, a partial opioid agonist that has weaker activation of opioid receptors but is well tolerated; and naltrexone, an opioid antagonist that blocks the activation of opioid receptors.

  • Surgeons write 36.5% of outpatient prescriptions for opioids, and, therefore, we are uniquely positioned to effect change in the opioid crisis at the local, state, and national levels.

INTRODUCTION

The health consequences of alcohol abuse and nonmedical use of prescription opioid pain relievers are significant. Recent reports indicate that excessive alcohol consumption is responsible for 88,000 deaths annually, making alcohol use the third leading preventable cause of death in the United States. In 2016, 10,497 people died in alcohol-impaired driving crashes, accounting for 28% of all traffic-related deaths in the United States.1

Equally concerning is that public health authorities have noted an unprecedented increase in the morbidity and mortality associated with opioid pain relievers. Between 1999 and 2016, more than 630,000 people died from a drug overdose in the United States. In addition, in 2016, a record number (63,632) of drug overdose deaths occurred, a rate of 19.8 per 100,000 persons.2 These alarming statistics are consistent with the dramatic rise of opioid pain reliever use over the past 15 years. Even the lay press is replete with articles and books documenting this major public health challenge.3-5

An integral part of substance abuse, whether alcohol or drugs, is addiction. According to the National Institute on Drug Abuse, drug addiction is a “chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and changes in the brain, which can be long lasting.”6 The Centers for Disease Control and Prevention (CDC) cites that 48.5 million persons in the United States, or 18% of persons 12 years of age or older, reported the use of illicit drugs or the misuse of prescription drugs in the past ...

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