TY - JOUR T1 - Addressing the ignored complication: chronic opioid use after surgery JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 180 LP - 182 DO - 10.1136/bmjqs-2020-011841 VL - 30 IS - 3 AU - Scott G Weiner Y1 - 2021/03/01 UR - http://qualitysafety.bmj.com/content/30/3/180.abstract N2 - We are all familiar with the dictum ‘primum non nocere’—first, do no harm. The Latin word ‘nocere’ is commonly interpreted as ‘harm’, but it shares a root with ‘pain’—think ‘nociceptor’ as an example. But what happens when the treatment of pain becomes the source of the harm? Only recently, we have recognised that prescribing excess opioids to previously naïve patients who undergo surgery and subsequently become chronic users is a ‘never event’ that we must strive to avoid.1–3 I first learnt about this problem several years ago, not from a research report but rather from my son’s soccer coach. He told me about his experience after a lumbar discectomy. After a straightforward outpatient procedure, he was sent home with a prescription for 30 tablets of oxycodone. For the first few days, he experienced expected discomfort and took oxycodone, ibuprofen and acetaminophen. After that, the pain improved, and he discontinued oxycodone after using about 10 tablets. That night, he experienced the worse sensation he ever had, including restlessness, chills and diffuse body aches. He took an oxycodone and nearly immediately felt better. The following morning, he was insightful enough to realise what was happening: he was experiencing opioid withdrawal.In our discussion about this experience, we reflected on how rapidly the brain adapts to opioids and how quickly withdrawal can occur. We also considered what would happen to a patient who did not have this insight the following morning and who continued to take the prescribed opioids in order to avoid the symptoms of withdrawal. Some patients must think: ‘The doctor gave me thirty … ER -