Substance Use - Illicit Substances

Substance use is associated with increased postoperative complications, prolonged hospital length of stay, and increased healthcare costs. (1-4) Acute intoxication and chronic use have implications for perioperative care. (5)

Additional challenges depend on the severity and type of substance(s) used, as well as other factors that may be associated with substance use, including experiencing homelessness or mental illness. Collaboration with community providers is important, especially for patients being treated for opioid use disorder.

Screening Tools

Screening Questions:

  • In the last 12 months, have you used drugs other than those required for medical reasons? (not including alcohol or cannabis)
  • If yes, characterize drug use (drug, dose, frequency, and route of administration)

The Drug Abuse Screening Test (DAST-10) is a validated 10-item brief screening tool that assesses drug use (excluding alcohol and tobacco), in the past 12 months and gives a score of the degree of problems related to drug use and misuse. (6,7) This allows preoperative interventions to target those patients with substantial or severe problems related to drug abuse.

Drug Abuse Screening Test (DAST-10)

Prehabilitation and Optimization Algorithm

Prehabilitation and Optimization Recommendations

Patient Education
  • Advise patients on the perioperative risks of substance use. (8)
  • Advise patients that elective surgical procedures will be delayed if they are acutely intoxicated. (8)
  • Recommend support services:
    • Encourage patients to see their healthcare provider for safe ways to decrease substance use before surgery.
    • Online services: available at Help Starts Here
    • Telephone service: 24-hour BC Alcohol and Drug Information and Referral Service toll-free from anywhere in B.C. at 1-800-663-1441
Referral for Safe Tapering Support
  • Addiction Medicine or Primary Care with/without RACE line support
Screen for Comorbid Disease
  • CBC
  • EKG
  • HIV
  • Hep B
  • Hep C
Referral for Anesthesia Consult
  • To develop effective pain management strategies and explore options for anesthesia and postoperative pain control, especially in moderate to severely invasive surgery
Postoperative Care for Inpatients
  • Referral to Addiction Medicine consultative services to avoid complicated withdrawal and facilitate discharge planning and supports

References

1. Kulshrestha, S., Bunn, C., Gonzalez, R., Afshar, M., Luchette, F. A., & Baker, M. S. (2021). Unhealthy alcohol and drug use is associated with an increased length of stay and hospital cost in patients undergoing major upper gastrointestinal and pancreatic oncologic resections. Surgery, 169(3), 636–643. https://doi.org/10.1016/j.surg.2020.07.059

2. Venishetty, N., Nguyen, I., Sohn, G., Bhalla, S., Mounasamy, V., & Sambandam, S. (2023). The effect of cocaine on patients undergoing total hip arthroplasty. Journal of orthopaedics, 43, 64–68. https://doi.org/10.1016/j.jor.2023.07.029

3. Best, M. J., Buller, L. T., Klika, A. K., & Barsoum, W. K. (2015). Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers. The Journal of arthroplasty, 30(7), 1137–1141. https://doi.org/10.1016/j.arth.2015.01.052

4. Raso, J., Althoff, A., Brunette, C., Kamalapathy, P., Arney, M., & Werner, B. C. (2023). Preoperative Substance Use Disorder Is Associated With an Increase in 90-Day Postoperative Complications, 1-Year Revisions and Conversion to Arthroplasty Following Arthroscopic Rotator Cuff Repair: Substance Use Disorder on the Rise. Arthroscopy : the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 39(6), 1386–1393.e4. https://doi.org/10.1016/j.arthro.2022.12.026

5. Jimenez Ruiz, F., Warner, N. S., Acampora, G., Coleman, J. R., & Kohan, L. (2023). Substance Use Disorders: Basic Overview for the Anesthesiologist. Anesthesia and analgesia, 137(3), 508–520. https://doi.org/10.1213/ANE.0000000000006281

6. Yudko, E., Lozhkina, O., & Fouts, A. (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. Journal of substance abuse treatment, 32(2), 189–198. https://doi.org/10.1016/j.jsat.2006.08.002

7. Gavin, D. R., Ross, H. E., & Skinner, H. A. (1989). Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. British journal of addiction, 84(3), 301–307. https://doi.org/10.1111/j.1360-0443.1989.tb03463.x

8. Gould, R., Lindenbaum, L., & Rogers, K., (2024). Anesthesia for patients with substance use disorder or acute intoxication. UpToDate. Retrieved Aug 24, 2024, from  https://www.uptodate.com/contents/anesthesia-for-patients-with-substance-use-disorder-or-acute-intoxication