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, according to a study in the February 2026 issue of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA). The study documents a steady rise in surgical patients using medications for opioid use disorder (MOUD), highlighting a gap between current surgical pain practices and the needs of today's patients.
"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, M.D., Ph.D., University of Michigan, Ann Arbor. "If you or a loved one are on a treatment for opioid use disorder and need surgery, your care team needs to know."
MOUD are an essential treatment strategy for patients with opioid use disorder. Medications such as the opioid buprenorphine can reduce cravings and withdrawal symptoms and improve health outcomes, including a reduced risk of opioid overdose.
"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 included data on adults hospitalized for major surgery, drawn from a national insurance database. Trends in the use of MOUD were assessed, including the types of surgeries associated with the highest prevalence of MOUD use. The analysis included 8.1 million surgical admissions between 2016 and 2022.
During this time, the rate of MOUD use among surgical patients increased significantly: from 154.4 per 100,000 procedures in 2016 to 240.8 per 100,000 procedures in 2022. Throughout the study period, about 80% of MOUD users were taking buprenorphine, which has advantages in safety and pain control compared to other options (e.g., 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. However, the single most common procedure was surgery (debridement) for serious infections: a common complication of intravenous drug use.
Increases in MOUD use were greater for men than women and in rural versus urban areas. Patients in the Midwest and Northeast regions had higher rates of MOUD use, compared to those in the West and South.
The study is the first to document rising rates of MOUD use among patients undergoing surgery. The authors note that their analysis of insurance claims data likely underestimates the true number of surgical patients receiving MOUD.
"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 emphasize the need to develop evidence-based guidelines for anesthesia and pain management in patients receiving MOUD.
The study provides "startling evidence" that every anesthesiologist is likely to encounter patients with substance use disorders – including patients taking MOUD, according to an accompanying editorial by Lynn R. Kohan, M.D., and Eugene R. Viscusi, M.D. They 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."
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