Opioid Stewardship in Acute Pain Care Must Go Beyond Prescription Reduction

Pharmacy Times interviews Tanya J. Uritsky, PharmD, BCPP, FPPCP, FASHP, on why effective opioid stewardship in acute pain care must extend beyond prescription reduction to include multimodal analgesia, patient-centered outcomes, and standardized health-system pathways.

Uritsky explains that successful opioid stewardship should not be defined solely by reductions in opioid prescribing or morphine milligram equivalents. Although lowering opioid exposure can be appropriate, an overly narrow focus on prescribing reductions may contribute to undertreated pain and other forms of patient harm. Instead, stewardship should include system-level access to multimodal analgesia, harm-reduction measures such as naloxone access, monitoring for overly rapid opioid tapering, and attention to patients who are admitted or readmitted because of pain. She also emphasizes the importance of including patient representatives in pain-management initiatives so that the patient perspective is reflected in decisions affecting care.

Implementing consistent multimodal pathways across a large health system can be difficult because of the number of hospitals, departments, clinical settings, and stakeholders involved. Electronic health records can support standardized pathways and clinical decision-making, but they may also create barriers when documentation templates and workflows vary among clinicians. Uritsky stresses that pathways should serve as evidence-based frameworks rather than inflexible policies, allowing clinicians to apply judgment and individualize treatment.

She also argues that hospitals need broader measures of success. Patient experience, return to physical function, recovery after surgery, persistent opioid use, and appropriately managed length of stay may provide a more complete picture than opioid consumption alone. The goal, she says, should be to help patients recover safely and efficiently without discharging them prematurely or withholding necessary analgesia. Together, these approaches can help health systems balance opioid safety, effective pain relief, and meaningful patient outcomes. This framework positions pharmacists as contributors to pathway design, medication safety, outcomes monitoring, and interdisciplinary care.