Critical Care is impacted by opioids in multiple ways. Not only do they form the backbone of managing pain and sedation in the intensive care unit (ICU), the burgeoning opioid epidemic also feeds into opioid-related ICU admissions.

While managing acute opioid overdose and acute withdrawal is vital, providing sufficient analgesia to critically ill patients and preventing opioid dependence challenges critical care providers.

ICU-acquired opioid dependence and chronic pain disorders after critical illness contribute to post-intensive care syndrome (PICS), and preventing them provides ICU caregivers an opportunity to improve outcomes in ICU survivors.

Management of acute pain in critically ill patients is a cornerstone of excellent ICU care; however, opioid stewardship in the ICU is imperative.

Frequent pain assessment, use of the lowest effective opioid dose, a multimodal approach to pain management, ongoing evaluation of medication appropriateness, and vigilance at transitions of care are key strategies in preventing development of potential OUD in ICU survivors.

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