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Malini Ghoshal,1 Hannah Shapiro,2 Knox Todd,3 Michael E Schatman4,5 1Inspirra Healthcare, Plano, Texas, USA; 2Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA; 3Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center Houston, Texas, USA; 4Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, Massachusetts, USA; 5Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA Correspondence: Michael E Schatman Tel +1(425)647-4880 Email Michael.Schatman@tufts.edu Although it is widely recognized that the United States has a severe and broad systemic racism problem, recent events have dramatically elevated the issue. Widespread protests in the US and around the world have brought much-deserved attention to the plights of Blacks, Indigenous and People of Color (BIPOC) regarding injustices that they experience on a daily basis. For the sake not only of BIPOC, but communities and societies as a whole, racial injustice can no longer be ignored or minimalized.1

Michael E Schatman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA, Tel +1 425-647-4880, Email Michael.Schatman@NYULangone.org

John F Peppin,1 Robert B Raffa,2– 5 Michael E Schatman6,7 1Department of Internal Medicine, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA; 2Temple University School of Pharmacy, Philadelphia, PA, USA; 3University of Arizona College of Pharmacy, Tucson, AZ, USA; 4Neumentum, Inc., Morristown, NJ, USA; 5Enalare Therapeutics, Naples, FL, USA; 6Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 7Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Correspondence: Michael E Schatman Tel +1 425 647-4880 Email Michael.Schatman@tufts.edu In the late 1990s and early 2000s, it was recognized that an increasing number of people were dying from opioid overdose, and regulatory agencies, professional societies, and legislative bodies actively adopted and promulgated efforts to reduce the “epidemic”. Yet, despite multiple guidelines, legislative enactions (often draconian), and attempts at legal and financial-penalty remedies, death rates continue to climb. The literature is now replete with the terms “opioid-induced respiratory depression” and “opioid overdose death” to describe the cause of death in many of these cases. Unfortunately, this terminology is too simplistic and now woefully outdated. It understates the complexities of these deaths, and the fact that the majority of overdose deaths currently involve multiple substances – that is, it is now a polysubstance-overdose death crisis.

Alaa Abd-Elsayed,1 Ann M Heyer,1 Michael E Schatman2– 4 1Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 2Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU School of Medicine, New York, NY, USA; 3Division of Medical Ethics, NYU School of Medicine, New York, NY, USA; 4School of Social Work, North Carolina State University, Raleigh, NC, USA Correspondence: Alaa Abd-Elsayed Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792-3272, USA Tel +1 608 263 6039 Email [email protected]

Erika A Petersen,1 Michael E Schatman,2– 4 Dawood Sayed,5 Timothy Deer6 1Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 3Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 4School of Social Work, North Carolina State University, Raleigh, NC, USA; 5Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 6Spine and Nerve Center of the Virginias, Charleston, WV, USA Correspondence: Michael E Schatman Tel +1 425-647-4880 Email [email protected]

Michael E Schatman,1– 3 Hannah Shapiro3,4 1Division of Medical Ethics, NYU School of Medicine, New York, NY, USA; 2Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA; 3School of Social Work, North Carolina State University, Raleigh, NC, USA; 4McLean Hospital, Division of Alcohol, Drugs, and Addiction, Harvard Medical School, Boston, MA, USA Correspondence: Michael E Schatman Division of Medical Ethics, Department of Population Health, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA Tel +1 425-647-4880 Email [email protected]

Evan Peskin,1 Jeffrey Gudin,2 Michael E Schatman3,4 1Department of Pain Management - Insight Institute of Neurosurgery & Neuroscience, Flint, MI, USA; 2Professor of Anesthesiology, Perioperative Medicine and Pain Management - University of Miami, Miller School of Medicine, Miami, Fl, USA; 3Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 4Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA Correspondence: Michael E Schatman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA, Tel +1 425-647-4880, Email [email protected]

Edward R Mariano,1,2 Michael E Schatman3,4 1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; 2Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; 3Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 4Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA Correspondence: Edward R Mariano Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 3801, Miranda Avenue (112A), Palo Alto, CA 94304, USA Tel +1 650 849-0254 Fax +1 650 852-3423 Email emariano@stanford.edu “Enhanced recovery” in the context of a surgical patient is both a plan and a goal at the same time. The goal is faster convalescence after surgery with positive outcomes and no complications. The plan takes the form of an enhanced recovery protocol (ERP) or clinical pathway specific to a surgical procedure, a concept pioneered by Professor Henrik Kehlet from Denmark decades ago.1 Over time, this basic concept has evolved and has become arguably too complex. With over twenty elements frequently included in modern ERPs, it is not surprising that consistent implementation and adherence are lacking.2 Not all of these elements are critical, and a study of an ERP for bowel resection has demonstrated that three are particularly important: 1) laparoscopic (minimally invasive) approach; 2) early termination of intravenous fluid; and 3) early mobilization (getting out of bed).3

Purpose of Review Appropriate use of opioid analgesics is a key concern within the field of pain medicine. Several methods exist to discourage abuse and facilitate effective treatment regimens. Pill counting is often cited as one such method and frequently employed in varying fashions within clinical practice. However, to date, there is no published review of the evidence to support this practice. This was a comprehensive review of the available literature that was conducted with analysis of the efficacy and practical application of pill counting during treatment of chronic pain conditions. Recent Findings There is paucity in data regarding pill count importance in pain management. Pill count is a very important tool to monitor compliance of opioids use which in turn can prevent several complications associated with opioid misuse. Summary Pill counting may be used in conjunction with other abuse deterrents, although increased support for this practice requires standardized methods of pill counting and further analysis of its effectiveness.

Chelsey Hoffmann,1 Michael E Schatman2,3 1Department of Medical Education, Mayo Clinic School of Health Sciences, Rochester, MN, USA; 2Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 3Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA Correspondence: Michael E Schatman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA, Tel +1 425-647-4880, Email [email protected]