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

OBJECTIVES: Preoperative use of nonprescribed stimulants can negatively affect surgical outcomes. When patients screen positive for stimulants on the day of surgery, many anesthesiologists and surgeons will postpone elective surgery to prevent negative anesthetic and surgical outcomes. However, cancelling elective surgery can lead to negative consequences such as delayed treatment, decreased patient satisfaction, increased surgical wait times, and increased costs to the institution due to lost productivity. In response, our facility's perioperative pain management team, the transitional pain service, established a perioperative contingency management program, an evidence-based treatment for substance use disorders that provides reinforcing consequences for healthy behaviors. We present the case of one patient enrolled in this program. METHODS: An adult patient with a history of stimulant use and osteoarthritis scheduled for right total hip arthroplasty at a tertiary care Veterans Affairs hospital tested positive for methamphetamines on routine preoperative urine drug screen and was cancelled on the day of surgery. The patient was referred to the transitional pain service for perioperative contingency management. RESULTS: The patient completed the 12-week program, and had a successful right total hip arthroplasty. The patient self-reported continued abstinence from methamphetamines 9 weeks after completing the perioperative contingency management program. CONCLUSIONS: This case report demonstrates that it is possible for a nonaddiction medicine specialty group to implement perioperative contingency management, which may improve patient access to surgery while offering a treatment that some patients may not otherwise pursue. This presents an opportunity for addiction medicine specialists to collaborate with multidisciplinary team members to expand addiction care beyond traditional settings.