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Surgery Plays a Key Role in Long-Term Opioid Use

A new study from Michigan OPEN researchers suggests that having surgery may come with an additional risk: the risk of becoming a long-term opioid user.

The team reviewed data from more than 36,000 nonelderly adults with private insurance who had only one operation in a two-year period from 2013 to 2014. None had an opioid prescription in the year preceding the operation.

About 6 percent of people who hadn’t been taking opioids before an operation but were prescribed the drugs to ease postoperative pain still refilled the drugs three to six months later. The average number of postoperative prescriptions was 3.3, adding up to about 125 pills. The rate didn’t differ between patients who had minor or major surgery.  It was also 12 times higher than the rate of long-term opioid prescription filling seen in a control group of similar adults who didn’t have surgery during the study period.

The Michigan OPEN team found that certain factors made some “opioid-naïve” surgery patients more likely to refill opioid prescriptions for months afterward.

Those who had been smokers or were diagnosed with alcohol, drug, depression, anxiety or chronic pain conditions before their operations had a higher rate of persistent prescriptions.

This suggests other reasons that patients might keep up opioid use months after an operation — despite a lack of evidence that the drugs help chronic pain or other long-term issues.

“This points to an under recognized problem among surgical patients,” says Chad Brummett MD, the first author of the study and one of the co-directors of Michigan OPEN. “This is not about the surgery itself, but about the individual who is having the procedure and some predisposition they may have. And we know that continued opioid use is probably not the right answer for them.”

The team continues to study the issue in hopes of developing better processes for surgical teams to predict and manage the risk of long-term opioid use among their patients. The researchers launched an effort to help surgical teams prescribe opioids appropriately in the weeks immediately before and after an operation or procedure which can be found at opioidprescribing.info. The team plans to update these recommendations regularly.