Author: Megan Rolfzen, MD
IARS and SOCCA 2026 Annual Meeting coverage
Traditional opioid risk assessments rely heavily on demographics, medical history, psychiatric conditions, and social factors. At the 2026 IARS and SOCCA Annual Meeting, researchers proposed adding another potentially important predictor: how an individual feels after receiving an opioid.
The United States remains in the third wave of the opioid epidemic, characterized by illicit fentanyl and approximately 220 deaths each day. Perioperative opioid exposure is especially important because surgery may represent a patient’s first meaningful encounter with prescription opioids.
Chad Brummett, MD, reviewed the problem of new persistent opioid use, generally defined as opioid consumption continuing beyond the expected period of surgical recovery. Depending on the procedure and population studied, this occurs in approximately 6% to 19% of patients.
Opioid prescribing and consumption vary substantially between countries. The United States and Canada generally report higher postoperative opioid use than countries such as Sweden, suggesting that prescribing culture and health system practices influence exposure.
Commonly recognized risk factors include:
- Living in a socioeconomically deprived community
- Male sex
- Psychiatric illness
- Previous substance use
- Greater opioid consumption during the first 30 days after surgery
Reducing prescription quantities and limiting refills have lowered overall exposure, but these policies do not identify every vulnerable patient. A smaller group continues to develop persistent use despite broad prescribing reforms.
Daniel Larach, MD, MS, MA, discussed the “preaddiction” period—the interval between initial opioid exposure and the development of a diagnosable opioid use disorder.
The transition to addiction is often described as a three-stage cycle involving rewarding intoxication, withdrawal with negative emotional effects, and preoccupation or craving. However, longitudinal human studies examining this progression remain limited.
Dr. Larach proposed studying two subjective responses after opioid exposure:
- The rewarding or euphoric effect—the “high”
- The unpleasant emotional decline afterward—the “crash”
If these reactions reliably predict later opioid misuse, clinicians may be able to personalize prescribing before a disorder develops. A patient who experiences unusually strong pleasure, mood elevation, or craving after an opioid may require a different postoperative pain plan than someone who experiences analgesia without significant reward.
Marie Eikemo, PhD, examined how a patient’s emotional state at the time of opioid administration may influence the drug’s subjective effects. The ongoing Norway Operations and Opioids study is prospectively following surgical patients to evaluate how emotional context affects opioid use and vulnerability.
Preliminary findings suggest that stress increases oxycodone self-administration, particularly among men. Previous opioid exposure may also alter the response. Patients with prior exposure were more likely to report improved well-being after taking an opioid, while opioid-naïve patients experienced this effect less frequently.
These findings suggest that opioid risk is influenced not only by the medication and dose but also by:
- The patient’s stress level
- Emotional state during exposure
- Previous opioid experience
- Individual sensitivity to reward
- The degree of mood improvement produced by the drug
Key Takeaways
New persistent opioid use affects a meaningful proportion of surgical patients, but standard demographic and clinical risk factors do not identify everyone who is vulnerable.
The number of opioids consumed during the first month after surgery is associated with the likelihood of prolonged use, reinforcing the importance of monitoring actual consumption rather than prescription size alone.
A strong euphoric response, improved emotional well-being, craving, or a significant emotional “crash” after opioid use may eventually become clinically useful warning signs.
Stress and emotional context may increase opioid self-administration, suggesting that perioperative anxiety and psychological distress should be considered when creating postoperative pain plans.
Future risk assessments may combine traditional factors, biological information, prescribing data, and patient-reported subjective responses.
Anesthesiologists are well positioned to identify vulnerable patients during a controlled episode of opioid exposure. Recognizing an unusually rewarding response could allow clinicians to intensify follow-up, reduce additional exposure, emphasize nonopioid treatments, and intervene before persistent use or opioid use disorder develops.
Thank you to IARS and SOCCA for allowing us to summarize this important coverage from the 2026 Annual Meeting.