1 in 5 people who are “opioid naïve” continue to take pain medication 3 months after surgery


New research shows that about 1 in 5 adults who are “opioid-naïve” continued to use pain relievers three months after having a procedure.

People with depression, bipolar disorder, pulmonary hypertension, or who smoked were among those most at risk of continuing to take opioids, according to findings presented at the 2021 Anesthesiology Annual Meeting held 8-12 October in San Diego, California. .

“The more than 100 million surgeries in the United States each year create an unintentional and alarming gateway to long-term opioid use,” said Gia Pittet, PhD, doctor of audiology, lead author of the study and visiting graduate researcher in anesthesiology and perioperative. medicine at the University of California, Los Angeles, in a statement.

Risks of Long-Term Opioid Use

People who use opioids for the long term are at risk for opioid dependence and overdose. Although most drug overdose deaths are caused by synthetic opioids, including illegally manufactured or distributed fentanyl, an estimated 14,139 people in the United States died from prescription opioid overdoses in 2019, according to data released by the Centers for Disease Control and Prevention (CDC). by the National Institute for Drug Abuse Control.

Respiratory complications, increased risk of falls and fractures, chronic constipation, heart attacks and immunosuppression are some of the health problems associated with long-term opioid use, according to previous research.

Persistent Opioid Use After Surgery Should Be the Exception, Not the Rule

Investigators collected data from hospital records of 13,970 people who had surgery at UCLA between 2013 and 2019. Subjects were considered opioid naive if they had not filled a prescription for it. opioids for 31 days to a year before surgery; patients are often prescribed opioids in advance, so that they are available immediately after surgery.

Records indicated that 21.2 percent of people renewed their opioid prescription three months to one year after the procedure.

Investigators also found that procedures involving the heart, foot or ankle and cataract surgery were associated with an increased risk of persistent opioid use.

These results provide important information because they specifically examine a large number of opioid-naive patients, says Kiran Rajneesh, MD, neurologist, pain physician and director of the neurological pain division at Ohio State Wexner Medical Center. University in Columbus.

“These results are alarming, but it’s something we are seeing in the real world – patients who have never taken opioids and then receive them on prescription, in this case. [after] surgery – and then months or a year later, they’re still taking opioid drugs, ”says Dr. Rajneesh.

There are situations where a person’s illness, type of surgery (for example, if there is follow-up surgery planned) or if there are complications during the surgery that might require them to continue to take opioids three months later, but these cases are the exception rather than the rule, he says.

Smoking, depression, bipolar disorder and pulmonary hypertension associated with continued opioid use

The researchers then analyzed 46 potential risk factors that may be associated with persistent opioid use, and the top four were smoking, bipolar disorder, depression, and pulmonary hypertension. Pulmonary hypertension occurs when the pressure in the blood vessels leading from the heart to the lungs is too high, resulting in less oxygen in the blood.

It makes sense that these conditions pose a higher risk of persistent opioid use, Rajneesh explains. “We know that in established chronic pain patients, there is a great overlap between mental health issues and chronic pain. Often times, underdiagnosing these conditions or not treating them effectively will lead to inadequate pain treatment, ”he says.

“All of these four disorders are related – they are related to mental health and well-being. Better access to mental health could help improve this situation, ”says Rajneesh.

Team-Based Approach to Health Care Could Help Prevent Opioid Overuse

“The authors mention the need for close follow-up after surgery, and I agree that this is very important,” says Rajneesh. The prescribing physician must be very accessible by phone or in person, he adds.

“A multidisciplinary or team approach is needed, which will often include the surgeon, pain specialist, physiotherapist and social workers. Right now the way health care works, a patient has surgery, he sees his surgeon, and then the surgeon takes the patient off the drug, ”he says. This can lead to gaps in care and allow continued persistent opioid use, he adds.

“A team approach can help meet the timing of stopping opioid use and help execute a treatment plan to relieve the patient of pain and return to function,” says Rajneesh.

Providers should also set expectations with patients, he says. “We have to tell patients that the drug is only for surgery and the recovery period. There may be a need for flexibility, which could be determined by careful monitoring, Rajneesh says.

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