Substance Abuse Disorder (Perioperative)

Incidence in USA (2013 estimation): 24.6 million (9.4% population)

Marijuana 7.5%, heroin 0.27%, cocaine 0.6%, prescription drugs 2.5%, alcohol (heavy drinkers) 6.5%, tobacco products 25.2%

Associations: Males, trauma, gunshot wounds, MVAs, falls, mental illness

Difficult airway and IV access

Hemodynamic instability, autonomic dysfunction

Opioid tolerance, achieving adequate analgesia, hyperalgesia/pain intolerance

Systemic/blood borne infections (HIV, hepatitis B and C, TB, septic arthritis)

Malnutrition, coagulopathy

Withdrawal (prevention and treatment)

Pain management

Acute psychosis (hallucinations, aggression, anxiety)

Multiagent abuse, drug interactions, smoking, and drug-related lung disease

Obstetrics: Lack of prenatal care, IUGR, 4× increased incidence of abdominal delivery, abruptio placenta, fetal abnormalities, drug effects that may mimic preeclampsia

Chronic condition characterized by (1) impaired control of use, (2) social impairment, (3) risky use of substance, and (4) pharmacologic effects (tolerance, withdrawal)

Physiologic and pathologic changes specific to drug class