The landscape of perioperative care in the United States is evolving, particularly for patients receiving medications for opioid use disorder, often referred to as MOUD. As the opioid crisis continues to influence public health policy and clinical practice, more patients in recovery are presenting for surgical procedures while actively using evidence based treatments such as buprenorphine. This shift creates both opportunities and challenges for anesthesiologists, surgeons, and perioperative teams.
Recent clinical research published in Anesthesiology highlights a significant rise in the prevalence of MOUD use among commercially insured surgical patients between 2016 and 2022. These findings underscore the urgent need for standardized, evidence driven guidelines to ensure safe and effective perioperative pain management for this growing patient population.
Medications for opioid use disorder, including buprenorphine, methadone, and naltrexone, are widely recognized as first line treatments for opioid dependence. These therapies reduce relapse risk, improve survival, and support long term recovery. However, their presence complicates traditional approaches to surgical pain control.
Patients receiving MOUD often have altered opioid tolerance and unique pain pathways. Discontinuing these medications before surgery may increase the risk of withdrawal or relapse, while continuing them may raise concerns about postoperative analgesia effectiveness. As a result, perioperative pain management in this group remains an area of active debate and research.
A large cohort study analyzing data from the Merative MarketScan Commercial Database examined adults aged 18 to 64 undergoing major surgical procedures over a seven year period. The dataset included millions of privately insured patients across the United States, making it one of the most comprehensive analyses of its kind.
The study found that the adjusted prevalence of MOUD use before surgery nearly doubled during the study period. In 2016, approximately 55 patients per 100,000 surgical procedures were using MOUD. By 2022, that number had increased to nearly 100 per 100,000 procedures. This steady rise reflects broader improvements in access to addiction treatment and growing acceptance of MOUD as standard care.
Buprenorphine emerged as the most commonly prescribed medication, accounting for more than four out of five MOUD cases among surgical patients. This aligns with national prescribing trends that favor buprenorphine due to its safety profile and flexibility in outpatient settings.
The study also identified specific procedures with notably high rates of MOUD use. These included wound debridement, shoulder joint replacement, lower extremity amputation, and open fracture repair of the hip or pelvis. Many of these procedures are associated with trauma, chronic pain, or conditions linked to long term opioid exposure.
Orthopedic surgery in particular stood out as a specialty where MOUD use is especially prevalent. This finding has important implications for orthopedic surgeons and anesthesiologists who frequently manage complex pain scenarios in patients with prior opioid dependence.
The rising number of surgical patients receiving MOUD highlights a critical gap in perioperative care protocols. Many clinicians still rely on institution specific practices or anecdotal experience when managing these patients. Without consistent guidelines, care quality may vary widely across health systems.
Anesthesiologists, as perioperative medicine specialists, play a central role in navigating these complexities. Decisions about whether to continue or adjust MOUD therapy before surgery can influence pain control, length of hospital stay, and patient satisfaction. Inadequate planning may also increase the risk of postoperative complications or relapse.
The findings emphasize the need for multidisciplinary collaboration involving surgery, anesthesia, pain medicine, and addiction specialists. A coordinated approach can help balance effective analgesia with the principles of addiction recovery.
The growing prevalence of MOUD use among surgical patients strengthens the case for developing formal, evidence based perioperative guidelines. Such guidelines could provide clarity on medication continuation, multimodal analgesia strategies, and postoperative follow up.
Standardized recommendations would not only support clinicians but also improve patient confidence and safety. As more individuals with opioid use disorder successfully engage in treatment, the healthcare system must adapt to meet their needs across all care settings, including the operating room.
Professional societies and academic journals are increasingly calling attention to this issue. Editorials and commentaries accompanying the study reinforce the idea that perioperative medicine must evolve alongside advances in addiction treatment.
The increase in MOUD use among surgical patients represents progress in addressing opioid use disorder, not a setback. It signals that more individuals are accessing effective treatment and continuing it during major life events such as surgery. The challenge now lies in aligning perioperative care with this reality.
Future research should focus on comparative outcomes, optimal analgesic techniques, and patient centered approaches that support both pain control and recovery. As the evidence base grows, it will pave the way for clearer guidance and improved outcomes nationwide.
The rise in medications for opioid use disorder among commercially insured U.S. surgical patients between 2016 and 2022 marks a significant shift in perioperative care. Buprenorphine remains the most commonly used therapy, with particularly high prevalence in orthopedic and trauma related procedures. These trends highlight the urgent need for consistent, evidence based perioperative pain management guidelines tailored to patients receiving MOUD.
By recognizing and addressing these changes, clinicians can deliver safer, more compassionate, and more effective surgical care to a population that continues to grow.
Bicket MC et al. Trends in Use of Medications for Opioid Use Disorder among Commercially Insured U.S. Surgical Patients, 2016 to 2022. Anesthesiology. February 2026. American Society of Anesthesiologists.
This blog is for informational and educational purposes only and does not constitute medical advice. Clinical decisions should always be based on individual patient circumstances and professional medical judgment. Readers should consult qualified healthcare professionals for diagnosis and treatment guidance.
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