The move away from opioids in postsurgical pain management is reshaping clinical practice across the United States. Yet each year, millions of patients first receive opioids after routine procedures, creating a critical opportunity to reduce unnecessary exposure and lower the risk of dependence.
Despite the availability of non-opioid therapies, opioids remain the default in many care settings, and surgery is often a patient’s first exposure to them.
Innovation has broadened the range of non-opioid pain management options, including localized approaches designed to treat pain at its source, limit unnecessary opioid exposure and support recovery. But innovation alone is not enough. One of the greatest challenges for healthcare systems is ensuring patients can access these therapies. The issue is no longer whether effective non-opioid options exist, but whether healthcare systems, payers and reimbursement structures can support broad access to them.
Why clinical confidence does not always lead to adoption
The Pacira 2026 HCP Attitudes and Usage study of more than 300 surgeons, anesthesiologists and pharmacy directors found that safety, duration of pain relief and opioid reduction are among the top factors driving treatment decisions. However, cost, insurance coverage and formulary access remain primary barriers to broader use.
As a result, clinical confidence does not always translate into consistent use.
Many providers say non-clinical factors, including cost, insurance coverage and formulary access, significantly shape which therapies are used in practice. This creates a disconnect: therapies with meaningful clinical potential may still face adoption barriers in real-world healthcare settings.
How the NOPAIN Act is shaping non-opioid adoption
The NOPAIN Act represents an important policy milestone for non-opioid pain management, creating separate Medicare reimbursement for certain non-opioid therapies in ambulatory surgical settings. By addressing reimbursement barriers, the law aims to expand patient access and encourage broader adoption of non-opioid pain management.
Early signs point to progress, as providers report greater use of non-opioid options and health systems begin incorporating updated reimbursement pathways into practice. Still, implementation continues to evolve. Providers cite billing complexity, CMS guidance and the financial impact of adopting new therapies as ongoing considerations. As reimbursement pathways mature and payer coverage expands, providers may be better positioned to integrate appropriate non-opioid therapies into routine surgical care, helping more patients access evidence-based, non-opioid pain management.
EXPAREL: opportunity amid access constraints
EXPAREL® (bupivacaine liposome injectable suspension), developed by Pacira BioSciences, Inc., reflects the broader shift in non-opioid pain management, where strong clinical confidence is increasingly shaped by reimbursement, payer coverage and formulary access. As a long-acting, non-opioid option administered at or near the surgical site, EXPAREL is designed to provide postsurgical analgesia and support pain management and surgical recovery. In a recent HCP survey, sponsored by Pacira, clinicians consistently rated duration of pain relief, safety and opioid reduction as the strongest clinical attributes of EXPAREL.
In specialties such as orthopedics and plastic surgery, these benefits are supporting meaningful adoption. While a lot of progress has been made, EXPAREL still faces many of the same access barriers seen across the non-opioid landscape. Cost, formulary variability and reimbursement complexity continue to influence when and how it is used.
Closing the gap between innovation and access
Closing the gap between clinical confidence and real-world use will require coordinated action across providers, policymakers, payers and industry. For providers and health systems, this means assessing how non-opioid pain management strategies fit into evolving care pathways, especially as value-based models place greater emphasis on outcomes and efficiency.
For policymakers, payers and health systems, progress will depend on reimbursement pathways that support appropriate access to clinically suitable non-opioid options. As coverage expands and implementation matures, providers may be better equipped to integrate these therapies into routine care. Real-world evidence can further strengthen the case by demonstrating impact on:
- Length of stay
- Recovery timelines
- Total cost of care
- Opioid utilization reduction
- Operational efficiency
Education will also be essential. As new policies and reimbursement pathways emerge, providers and institutions need clear, practical guidance to put policy into practice.
The path forward
The shift toward non-opioid postsurgical pain management is already underway, driven by clinical need and policy momentum. Each year, nearly 37 million Americans undergo surgery, and up to 92% are discharged with an opioid prescription, underscoring the significant opportunity to reduce unnecessary opioid exposure through effective, evidence-based non-opioid options.
Achieving that goal requires making non-opioid options accessible, reimbursed and practical to use in everyday care.
To fully realize their potential, access must advance alongside evidence and the broader move away from opioid-first approaches. The next phase of non-opioid adoption will depend not only on new therapies, but also on whether patients and providers can access and implement them in routine clinical practice.
Important Safety Information
INDICATION
EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.
IMPORTANT SAFETY INFORMATION
EXPAREL should not be used in obstetrical paracervical block anesthesia.
In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.
In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, headache, and constipation.
In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.
EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.
EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.
Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.
EXPAREL should not be injected into the spine, joints, or veins.
The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.
Please refer to full Prescribing Information.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
PP-EX-US-10554 07/26