Anesthesia for SUD: Opioid-Free Approaches and SmartTIVA’s Vision

Exploring New Clinical Needs with the CBID Approach

Following guidance from Johns Hopkins’ Center for Bioengineering Innovation & Design (CBID), SmartTIVA is crafting a new clinical need statement centered on opioid-free anesthesia (OFA), a timely hot topic as overdose rates and related fatalities continue to climb in the USA. Opioid-free approaches aim to reduce perioperative opioid use, minimizing risks such as dependency and adverse side effects, including respiratory depression and gastrointestinal complications(perioperative opioids, …). However, whether a fully opioid-free approach is optimal remains a nuanced question, with varied perspectives from clinicians, nursing staff, and patient families (perioperative opioids, …).

SmartTIVA and the I4SUD Program

SmartTIVA’s involvement in the NIDA funded Innovation for Substance Use Disorder (I4SUD) program at The Johns Hopkins University - Carey Business School underscores our commitment to addressing the unique requirements of SUD patients in anesthesia and sedation care. Through the program, we’re validating an OFA version of SmartTIVA that integrates non-opioid agents, brain monitoring, and personalized dosing. This effort has required extensive fieldwork, including interviews with anesthesia professionals, nursing staff, and families of patients recovering from substance use disorder (SUD) or opioid use disorder (OUD). These discussions have provided critical insights into the expectations and challenges associated with anesthesia and sedation in this population.

Although this OFA solution has yet to be fully developed, our experience in product development and technical feasibility supports its potential. Additionally, the development of a clinical need statement may guide SmartTIVA toward a design pivot to better meet identified needs. Alongside this, we are evaluating intellectual property, technical feasibility, market opportunities, and reimbursement strategies—key steps to bring this approach to clinical settings.

Insights from Fieldwork: Varied Perspectives on Opioid-Free Anesthesia

Our interviews revealed an essential insight: anesthesia professionals, including anesthetists and clinicians, consistently noted that safely anesthetizing or sedating SUD patients is challenging and requires specialized strategies. This shared statement across professional perspectives underscores the need for adaptable, patient-centered solutions tailored to the specific needs of SUD patients.

Beyond this common factor among clinicians, perspectives on opioid-free anesthesia were diverse. Many recovering SUD and OUD patients, along with nursing staff and family caregivers, expressed strong reservations about opioids, associating them with potential relapse or dependency risks from perioperative prescriptions. We also encountered significant hesitancy among patients themselves, who were often wary of going to surgery due to anticipated opioid use, which they feared might increase addiction risks(perioperative opioids, …)(nihms-1056523).

However, some anesthesia professionals believe opioids are essential in controlled settings, suggesting that intrahospital opioids are less likely to trigger new addictions today given the regulations and controls that are already in place. Others advocate for a dedicated opioid-free treatment path in every hospital, especially in those within high OUD incidence areas like Baltimore, believing it would empower patients with choice and transparency about anesthesia options. In contrast, some regard OFA as a trend, arguing it might work as part of a tool belt approach but did not represent a revolution itself.

Is OFA the Future, or Just Part of a Broader Solution?

One insight from these discussions is that while opioid-free anesthesia offers distinct benefits, it can't exclude other methods. Many anesthesia professionals emphasized the value of a comprehensive, standardized guidelines for multimodal anesthesia and sedation which is still missing. Meanwhile, nursing staff and family caregivers often underscored the need for educational tools to demystify opioid use, while some pointed to emerging technologies like closed-loop anesthesia systems and AI-driven patient monitoring as promising solutions.

For SUD patients—who already pose unique challenges in anesthesia care—a thoughtful, adaptive approach is essential. Expanding guidelines and educating practitioners on the specific needs of these patients may be critical steps toward safely integrating OFA into practice.

Questions for the Future of Anesthesia Management

As SmartTIVA continues to refine its opioid-free approach, several questions arise about the future of anesthesia and sedation management:

• Are new addictions still being caused in hospital settings, as suggested by Dr. Bohringer in his 2020 article?
• Is an opioid-free treatment path a viable alternative?
• Could technology—such as AI— jump in as the standard for OFA, or are robust clinical guidelines necessary first to unify current practices?
• Is education and demystification enough, or does perioperative care require a broader transformation?

Through these questions, SmartTIVA is dedicated to bringing innovative, safe anesthesia solutions to the forefront of modern healthcare. For further reading on the role of opioids in the opioid crisis and perioperative care, see Dr. Larach’s ASA publication.