April 27, 2017

For many, chronic opioid use is a post-surgery complication, study finds

Daily Briefing

    About six percent of patients who underwent major or minor surgery between 2013 and 2014 and were prescribed opioids continued taking the opioids long-term, according to a study published recently in JAMA Surgery.

    Study details

    For the study, researchers reviewed insurance claims data on 36,177 patients from Jan. 1, 2012 to June 30, 2015. They identified individuals ages 18 to 64 who had major or minor surgery in 2013 or 2014, did not use opioids for one year leading up to the month prior to the surgery, and filled an opioid prescription within one month before or two weeks after surgery. The researchers then used the data to examine the incidence of long-term use of the opioids—use lasting longer than 90 days after surgery—among those patients and assessed the "data for patient-level predictors of persistent opioid use."

    Findings

    The researchers found that the rate of long-term opioid use was 6.5 percent among patients who had major surgery and 5.9 percent among patients who had minor surgery.

    According to the researchers, patients with comorbidities were more likely to use opioids long-term. In addition, they found that patients were more likely to use opioids long-term if they had histories of:

    • Alcohol and substance use disorders;
    • Anxiety;
    • Mood disorders;
    • Pain disorders, including arthritis, back pain, centralized pain, and neck pain; and
    • Tobacco use.

    Discussion

    The researchers wrote, "New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders." They added, "This suggests its use is not due to surgical pain but addressable patient-level predictors."

    Further, the researchers wrote that "because opioids are prescribed medications, patients may overestimate their safety and use opioids intended for postsurgical pain for other symptoms, such as back and neck pain, headaches, osteoarthritis, and insomnia, for which opioids are not effective," as well as "to treat emotional pain and affective distress."

    The researchers wrote that more attention should be placed on postoperative opioid prescribing and how it relates to the U.S. opioid misuse epidemic. "New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness," they concluded (Bachert, MedPage Today, 4/12; Brummett et al., JAMA Surgery, 4/12; Snyder, Axios, 4/12; Phillips, Medscape, 4/12).

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