ASA study says changes needed for pain management of surgical patients on MOUD treatments

A study in the February 2026 issue of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA), documents a steady rise in surgical patients who are being treated with medications for opioid use disorder (MOUD), which it says highlights a “gap between current surgical pain practices and the needs of today’s patients.”

“As more Americans receive treatment for opioid use disorder, that progress is increasingly showing up in the operating room, creating an urgent need to modernize how pain is managed during and after major surgery,” ASA said of the study.

“From the patient's perspective, our study reinforces that addiction treatment is medical care – not something to pause or hide before surgery,” said study lead author Mark C. Bicket, MD, PhD, an associate professor in the Departments of Anesthesiology and Health Management & Policy at the University of Michigan, and co-director of the Overdose Prevention Engagement Network. Dr. Bicket says patients who need surgery should alert their care teams if they are on MOUD treatments.

“Our study shows that more people arriving for surgery are already receiving MOUD, while our surgical system has not fully appreciated or adapted to that reality,” said Dr. Bicket. “This is a critical moment for safer, more coordinated care because growing numbers of patients on opioid use disorder treatment are entering the operating room without clear, coordinated plans in place to manage both pain and recovery.”

The study analyzed data from a national insurance database on 8.1 million adults who were hospitalized for major surgeries between 2016 and 2022. It assessed trends in the use of MOUD, including the types of surgeries associated with the highest prevalence of MOUD use.

The study found that the rate of MOUD use among surgical patients rose from 154.4 per 100,000 procedures in 2016 to 240.8 per 100,000 procedures in 2022, with about 80% of MOUD users taking buprenorphine, which it said has advantages in safety and pain control compared to other options such as methadone or naltrexone.

Most of the top ten procedures associated with MOUD use were orthopedic surgeries, including shoulder joint replacement, lower extremity amputation, or surgery for hip or pelvis fracture. The most common procedure, however, was debridement for serious infections that commonly arise from intravenous drug use.

ASA says the study is the first to document rising rates of MOUD use among patients undergoing surgery.

“Our findings reflect progress in getting people treated for opioid use disorder,” said Dr. Bicket. “However, they also highlight a growing need for hospitals to modernize their approach to pain management for major surgery because pain management practices built for the past don’t fully account for the needs of patients on modern treatments for opioid use disorder.” The researchers encourage the development of evidence-based guidelines for anesthesia and pain management in patients who are receiving MOUD.

In an accompanying editorial, Lynn R. Kohan, MD, and Eugene R. Viscusi, MD, wrote, “Anesthesiologists as champions of perioperative medicine are ideally suited to provide the care these patients demand and to integrate addiction management principles into perioperative care.”

Access the full study here.