Episode Summary: Tackling the Opioid Crisis with Dr. Asif Ilyas of Rothman Orthopaedic Institute

Becker’s Healthcare Podcast
Date: October 4, 2025
Host: Carly Beam
Guest: Dr. Asif Ilyas, Orthopedic Surgeon, Professor, and President of the Rothman Opioid Foundation

Overview

In this episode, host Carly Beam discusses the ongoing opioid crisis with Dr. Asif Ilyas of the Rothman Orthopaedic Institute. The conversation focuses on the work of the Rothman Opioid Foundation, strategies and research behind opioid-sparing pain management, legislative advocacy, and trends in opioid-related healthcare outcomes. Dr. Ilyas emphasizes the dual mission of addressing pain responsibly and minimizing the risks associated with opioid use.

Key Discussion Points & Insights

Background on Dr. Ilyas and the Rothman Opioid Foundation

• Dr. Ilyas is an orthopedic and hand surgeon, professor, and associate dean for clinical research, deeply involved in both clinical practice and research.
• The Rothman Opioid Foundation ("officially, the Rothman Institute Foundation for Opioid Research and Education" [02:13]) is a 501c3 nonprofit focused on opioid education, research, and evidence-based policy advocacy.
• Mission includes:
  1. Educating patients and prescribers on safe opioid use and prescribing.
  2. Executing and funding research on opioid-sparing and alternative pain management strategies.
  3. Advocating for evidence-based pain management policies at local, state, and national levels.
• "We established this nonprofit foundation ... to really dedicate time and resources to ... make a meaningful difference recognizing the edge associated with opioid abuse addiction that we were seeing." — Dr. Ilyas [02:32]

2025 Priorities and Annual Symposium

• The foundation will hold its annual symposium in early November, focusing on medical cannabis from scientific, research, and policy perspectives, bringing together researchers, clinicians, and policymakers. [03:38]

Legislative Advocacy in Pennsylvania

• Key initiatives:

  • Electronic Prescribing (e-prescribing):
    Modernizes opioid prescribing, reduces risk of manipulation and oversupply, and enhances monitoring.
    "E prescribing has created a system ... not only just modern ... but ... it eliminated manipulating of prescription." [05:35]

  • Prescription Drug Monitoring Program:
    An online database tracking controlled substance prescriptions to enhance transparency and decrease abuse.
    "...an online database ... prescribers can ... check ... before they prescribe to make sure that the patient is not getting too much or from too many different people." — Dr. Ilyas [06:40]

Challenges in Effective Pain Management and Opioid Stewardship

• The goal is not to be anti-opioid, but to act as "opioid stewards," using risk-based, patient-centered approaches.

• Core challenges include:

  • Balancing adequate pain control with minimizing risks of dependency or abuse.
  • Managing diverse patient dynamics (comorbidities, psychiatric conditions, substance abuse history).
  • Ensuring consistency among providers and evidence-based practice.

• "We're not anti opioids ... The strategy really is how do you manage patients' pain with minimizing or mitigating the risk associated with opioids." — Dr. Ilyas [08:18]

• Concept of opioid diversion: unused prescriptions can be misused within a patient's broader community.
  "If I give you a certain amount of ... opiates and you don't use them, it's now in your home and it's ... access to a lot of other people in your sphere of influence." [10:22]

Innovations and Strategies in Opioid-Sparing Pain Management

• Multimodal Pain Management:
  Using combinations of medications that target different parts of the "pain pathway" to reduce need for opioids:

  • Local anesthetics at surgical site
  • NSAIDs to decrease inflammation
  • Gabapentinoids (e.g., gabapentin, pregabalin) for nerve pain
  • Tylenol for general pain
  • Reserve opioids for breakthrough pain only

  "If you use these in combination, it can decrease the overall pain experience ... you can then reserve the use of opioids only for strictly backup or for severe breakthrough pain." — Dr. Ilyas [13:46]

• Preoperative Counseling:
  Educating patients before surgery about pain, pain management, opioid risks, and alternatives substantially reduces opioid need postoperatively.

  • Techniques include information packets and, preferably, short educational videos.

  "We found that when you ... provide some pain management education or counseling before surgery, patients do a much better job of managing their pain and can consume much less opioids." [15:16]

Wider Healthcare Trends and Remaining Concerns

• Increased public and provider awareness about opioid risks and alternatives is resulting in better prescribing patterns and cultural acknowledgment (e.g., in media).
• The sobering reality: only in 2024 did the U.S. see a slight decrease in opioid-related deaths—over 100 daily—driven now by illicit fentanyl and compounds like xylazine.
  • Xylazine being used as a fentanyl adulterant causes severe necrotic wounds—"melting away skin, muscle, tendons and down to bone, even ... requiring amputations." [18:31]
• "Although we did see a slight drop last year ... the numbers are still extremely high. And ... we're not seeing a strong decrease." — Dr. Ilyas [17:43]
• The foundation developed a consensus paper and working group on xylazine-associated wounds after a focused symposium in Philadelphia. [19:18]

Notable Quotes & Memorable Moments

• On the Foundation’s Mission:
  "The mission of the foundation is threefold. One is to educate patients and prescribers on safe opioid use and prescribing, respectively. Two is to perform and or fund research around opioid sparing or alternative pain management strategies. And third is to advocate for evidence based pain management policies." — Dr. Ilyas [02:30]

• On Multimodal Pain Management:
  "That's often all anybody needs and therefore mitigates even the need or eliminates the need for opioids altogether." — Dr. Ilyas [14:31]

• On Preoperative Counseling:
  "We advocate for is routine preoperative counseling through a ... short video that helps patients understand what pain is, how they can manage their pain, what opioids are, what the risk of opioids are, ... and if you do take opioids, how to take them safely." — Dr. Ilyas [15:34]

• On the Urgency of the Crisis:
  "Opiate related deaths are the leading cause of death of young adult Americans, surpassing car accidents and gunshot injuries. So it's a big problem." — Dr. Ilyas [17:08]

• On Emerging Threats:
  "We're also seeing increasing adulteration of fentanyl with a substance called xylazine ... and these wounds can be quite aggressive, cutting through, melting away skin, muscle, tendons and down to bone, even ... requiring amputations." — Dr. Ilyas [18:31]

Timestamps for Key Segments

• Dr. Ilyas introduces background and foundation: 01:06–02:23
• Foundation's mission and annual symposium focus: 02:10–04:45
• Legislative work: e-prescribing and monitoring programs: 05:09–07:17
• Challenges of opioid stewardship in pain management: 07:48–10:12
• Innovation: Multimodal pain management strategies: 11:34–14:30
• Innovation: Preoperative pain and opioid counseling: 14:30–15:46
• National trends and fentanyl/xylazine crisis: 16:13–19:31

Conclusion

Dr. Asif Ilyas and the Rothman Opioid Foundation are leading efforts in opioid stewardship through education, research, and policy, recognizing both the essential role and inherent risks of opioids in modern medicine. By developing evidence-based, patient-centric strategies such as multimodal pain management and enhanced preoperative counseling, they aim to mitigate opioid harm while ensuring effective pain relief. Though progress is evident in awareness and safer prescribing, the continued rise of illicit, adulterated opioids like fentanyl mixed with xylazine presents a new and urgent challenge for both healthcare providers and communities.