People still use opioids 3 months after surgery


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Experts say healthcare professionals should be aware of a person’s risk of opioid addiction before having surgery. blackCAT / Getty Images
  • Researchers say that about 20 percent of people continue to use opioids 3 months after surgery.
  • Experts say pain relievers are usually not needed more than 3 months after an operation.
  • They say healthcare professionals as well as patients need to be better informed about the potential risks of opioid addiction.

For post-surgical pain, few drugs provide more relief than opioid-based pain relievers.

However, these drugs have a high potential for abuse and dependence, and can be dangerous when use continues beyond the point where they are needed to manage post-surgical pain.

A new study shows that the potential abuse of opioids prescribed for postoperative pain is high enough to cause concern.

More than one in five ‘opioid naive patients’ – those who had not received another opioid prescription in the past year – continued to use pain relievers, UCLA researchers say. 3 months after undergoing surgery.

People who smoke and people with bipolar disorder, depression or pulmonary hypertension were most at risk of continuing to use opioid drugs beyond the point of probable medical need, according to research presented at the annual meeting ANESTHESIOLOGY 2021.

The research has not yet been peer reviewed or published.

“We know that after surgeries, the longer the prescription, the greater the risk of chronic” opioid use, “said Dr. Charles Luther, clinical assistant professor of psychiatry at the School of Medicine. ‘Case Western Reserve University in Ohio, and Chairman and Medical Director of the Department of Psychiatry at the Southwest General Health Center in Cleveland.

Luther told Healthline that other studies have shown that the risk of addiction increases sharply after just 7 days of using prescription opioid drugs, from around 6% to 13%.

Researchers said people who had never taken opioid drugs before may not be aware of their potential for abuse and dependence.

Luther said clinicians need to educate their patients about these risks and that patients have an obligation to educate themselves about the potential and warning signs of opioid use disorders.

Opioid abuse may include taking more medication than prescribed, continuing to use beyond the point where the pain has subsided, or taking medication for its psychological impact rather than to prevent the pain. physical.

“The more than 100 million surgeries in the United States each year create an unintentional and alarming gateway to long-term opioid use,” said Dr. Gia Pittet, lead author of the study and visiting graduate researcher in anesthesiology and perioperative medicine at UCLA.

Pittet said the results show that “the management of opioid administration in the postoperative period must extend well beyond the hospital stay,” including coordination between the patient’s surgical team and the primary care physician.

Dr Brian Wind, clinical director of the Journey Pure addiction treatment program, told Healthline that previous research has shown a link between the amount of opioids prescribed for postoperative pain and increased rates of addiction.

He noted that decreasing the amount of prescriptions could reduce the risk of addiction.

“Patients may not be sufficiently sensitized to the risks of opioid addiction. Prescribers can follow prescribed amounts of opioids by default, or even prescribe more for pain management, ”Wind said.

“There may also be not enough work done with patients to gradually reduce doses until they no longer need opioids, or not enough consideration of alternatives. non-opioid pain management that is effective and patient-centered, ”he said. .

Researchers studied the medical records of 13,970 opioid-naive adults who underwent surgery at UCLA hospitals between 2013 and 2019.

They found that 21% of study participants renewed their opioid prescription 3 months to 1 year after the procedure.

The researchers noted that, with the exception of people treated for cancer and those who experienced chronic pain before surgery, few people are expected to need to continue taking opioids for more than 3 months after surgery.

Pittet said that after surgery, people should receive counseling on the safe use of opioids and education on alternative pain management choices.

Luther added that some of these alternatives include exercise, acupuncture, yoga, tai chi, meditation, and biofeedback.

“We have to teach people how their mental state can affect their perception of pain,” he said.

People should also be closely monitored by their health care team while taking opioids, Pittet said.

“To reduce the likelihood of continued opioid use, anesthetists should use preoperative assessment to identify patients at greatest risk for persistent use,” Pittet said.

“Before undergoing surgery, patients who smoke should be encouraged to quit smoking, those with pulmonary hypertension should see a doctor to help them control the disease, and patients with bipolar disorder or depression may require preoperative medication adjustment, ”she said. noted.

Luther added that people with a family history of alcohol and other substance abuse should also be closely monitored after surgery, given that an estimated 40 percent risk of addiction has a genetic component.

“Opioids have a role to play. They can be a wonderful intervention, but they need to be used for a limited time, ”Luther said.

“Not all surgical procedures require an opioid prescription, but when they do [do], there needs to be a clear conversation between clinician and patient about duration and dose and the factors that go into opioid dependence, ”he said.

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