82 AANA Journal  October 2018  Vol. 86, No. 5 www.aana.com/aanajournalonline Sarah E. Giron, PhD, CRNA Robert A. Olson, DNAP, CRNA Charles A. Griffis, PhD, CRNA Peggy Compton, PhD, RN, FAAN The Opioid Crisis and the Certified Registered Nurse Anesthetist: Caring for Patients With Opioid Use Disorder in Drug-Free Recovery GUEST EDITORIAL Today’s Certified Registered Nurse Anesthetist (CRNA) cares for a very different patient population than that of our predecessors; we are doing more complex surgi- cal procedures, on older patients, with ever-increasingly complex comorbidities. When combined with a crisis of overuse of, over- prescription of, dependence on, and tolerance to a class of mainstay anal- gesic drugs, the result is the current predicament of administering anesthesia in the era of the opioid crisis. One of the fastest-growing groups of patients for whom we must tailor our anesthetics are those patients who have experienced or are currently experiencing opioid dependence. Opioid Use Disorder (OUD), the diagnostic term for opi- oid addiction, adds another facet to the complex history of patients who will enter the operating room. Unfortunately for all anesthesia practitioners, the best practices for anesthesia care of the patient with OUD are extremely limited. Recommendations from profes- sional organizations are lacking, the research to help drive evidence- based practice is still in its infancy, and the resources for practice are only beginning to emerge. As leaders of the perioperative team, CRNAs can and should spearhead the movement to safely and effec- tively care for this growing group of patients. Opioid misuse is estimated to affect more than 2 million Americans 1 and is pervasive and costly, accounting for nearly 100 deaths per day in the United States. 2 Given that opioid analgesics are a common component of anesthe- sia, how can we deliver safe and effective care to those who are in drug-free remission? This editorial will not only provide a background of this disorder, but also focus spe- cifically on recommendations and guidelines available to the anesthe- tist on the appropriate course of care for the surgical patient popula- tion with OUD. Review of the Literature OUD is a specifc class of substance use disorder that exhibits unique characteristics that can infuence the predisposition for, and course of, the disease. Factors contributing to the etiology of OUD range from genetic, pharmacologic, environmental, developmental, and other psychiatric comorbidities. 3 While it is outside the scope of this editorial to discuss all factors that contribute to the devel- opment and maintenance of OUD, a brief history of the pharmacologic and environmental contributions to this disease process can be traced to the very healthcare system charged with caring for these patients. The opioid crisis of today began over 30 years ago, when the general sentiment of American healthcare Opioid Use Disorder (OUD), the diagnostic term for opi- oid addiction, is estimated to affect millions of Ameri- cans and cost those who suffer it enormously. Given that opioid analgesics are a common component of anesthesia, how can we deliver safe and effective care to those who are in drug-free remission? This editorial will provide a background of this disorder, and will focus specifically on recommendations and guidelines available to the nurse anesthetist on the appropriate anesthetic care for the surgical patient population with OUD in recovery and not on maintenance therapy. Keywords: Opioid Use Disorder, opioids, relapse, opi- oid crisis.