The opioid crisis is in the national headlines almost daily. Many US states have enacted prescribing restrictions and stipulations to begin addressing the problem. While it is unclear how much of the excess supply of opioids in circulation stems from perioperative prescribing, significant variation in prescribing practices is clear.^1,2 We would argue that if practicing surgeons reflected on their own opioid prescribing practices, they would likely identify areas to improve. However, they would also realize the limited resources to appropriately set patient expectations for postprocedure pain and the paucity of evidence available to support approaches to calculating the dose and duration of opioids needed after common surgical procedures or the use of nonopioid analgesic regimens. In this issue of JAMA Surgery, Wetzel et al³ present a systematic review of interventions for postsurgical opioid prescribing, with a focus on system-level interventions, such as practice guidelines and electronic health record modifications. The authors conclude the same thing that many of us have come to realize in our daily practice: that there is evidence that these approaches are effective, but the literature in this area is very limited.

阿片类药物危机几乎每天都在国家头条新闻中。美国许多州已经制定了限制和规定，开始着手解决这个问题。虽然尚不清楚循环中阿片类药物的过量供应有多少来自围手术期处方，但处方实践中的显着变化是显而易见的。^{1 ，2}，我们会说，如果医生执业反映自己的阿片类药物处方行为，他们可能会找出需要改善。但是，他们也将认识到资源有限，无法适当地设定患者对术后疼痛的期望，并且缺乏足够的证据来支持在普通外科手术或使用非阿片类镇痛药后计算阿片类药物的剂量和持续时间的方法。在本期《 JAMA Surgery》，Wetzel等人³对手术后阿片类药物处方的干预措施进行了系统的综述，重点是系统水平的干预措施，例如实践指南和电子病历修改。作者得出的结论是，我们许多人在日常生活中已经意识到这一点：有证据表明这些方法是有效的，但是该领域的文献非常有限。