Utilizing the Transitional Pain Service to Provide Perioperative Contingency Management for Stimulant Use

Area of Science:

• Anesthesiology
• Addiction Medicine
• Pain Management

Background:

• Preoperative stimulant use can lead to elective surgery postponement.
• Surgery cancellation results in delayed treatment, decreased patient satisfaction, and increased costs.
• A perioperative contingency management program was implemented to address substance use disorders.

Purpose of the Study:

• To present a case study of a patient enrolled in a perioperative contingency management program.
• To demonstrate the feasibility of implementing such a program outside of traditional addiction medicine settings.

Main Methods:

• A patient with a history of stimulant use and osteoarthritis tested positive for methamphetamines preoperatively.
• The patient's elective right total hip arthroplasty was cancelled.
• The patient was referred to the transitional pain service for perioperative contingency management.

Main Results:

• The patient successfully completed the 12-week contingency management program.
• The patient underwent a successful right total hip arthroplasty.
• The patient reported continued methamphetamine abstinence 9 weeks post-program completion.

Conclusions:

• Perioperative contingency management can be implemented by nonaddiction medicine specialists.
• This program can improve surgical access for patients with substance use disorders.
• Collaboration between addiction medicine and multidisciplinary teams can expand addiction care access.