Persistent Opioid Use Common Following Surgery

insurance claims data to calculate incidence of persistent opioid use for more than 90 days among opioid-naive patients after minor surgical procedures (such as varicose veins, laparoscopic cholecystectomy and appendectomy, hemorrhoid treatments, and others), as well as following major surgical procedures, such as colectomy, reflux and bariatric surgery, and hysterectomy. The primary outcome was new persistent opioid use, defined as opioid prescription fulfillment 90-180 days after the surgical procedure.

The results showed that of 36,177 patients (average age 45 years, 66% female, 72% Caucasian) who filed claims in 2013-2014, 80% underwent minor surgical procedures. The rates of new persistent opioid use were similar among all patients, however, ranging from 5.9% to 6.5%. By comparison, the incidence of new opioid use in a non-operative control group was only 0.4%. Risk factors for new, persistent opioid use included preoperative tobacco use, alcohol and substance abuse disorders, mood disorders, anxiety, and preoperative pain disorders. The study was published on April 12, 2017, in JAMA Surgery.

“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,” concluded lead author Chad Brummett, MD, of the University of Michigan, and colleagues. “This suggests its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness.”

Prescriptions of opioid medications for chronic pain have increased dramatically, a trend that has been accompanied by greatly increased levels of prescription opioid overdose, abuse, addiction, and diversion. While opioid therapy has been found to be associated with alleviation of pain in the short term, most opioid trials do not extend beyond six weeks, and are of limited relevance to long-term opioid use.