Continued opioid use observed year after bariatric surgery

Many patients who underwent bariatric surgery continued to use chronic opioids more frequently than beforehand, according to retrospective data published in JAMA.

Before surgery, 8% of bariatric patients (n=933) were chronic opioid users, according to data. Subsequently, 77% of patients (n=723) continued chronic opioid use in the year after surgery, Marsha A. Raebel, PharmD, of the Institute for Health Research at Kaiser Permanente in Colorado, Denver, and colleagues wrote.

Ten varying demographic and geographic US health care systems were used for the study, in which 11,719 patients (aged 21 years and older) who underwent bariatric surgery between 2005 and 2009 were assessed to determine their opioid use.

Marsha A. Raebel

Researchers observed a mean daily morphine equivalent of 45 mg (95% CI, 40-50.1) in patients who used opioids before surgery; 51.9 mg (95% CI, 46-57.8) in those who used opioids after surgery.

Because of the avoidance of nonsteroidal anti-inflammatory drugs and lack of efficacy of acetaminophen, the options for pain medication are limited for patients undergoing bariatric surgery, according to the researchers. They said opioid use should be monitored closely, and chronic users often have risk factors for misuse, such as a history of substance abuse or mental health diagnoses.

In an accompanying editorial, Daniel P. Alford, MD, MPH, of the section of general internal medicine in the clinical addiction research and education unit at Boston Medical Center, wrote that ensuring the safe and appropriate prescribing of opioids for chronic pain has become a national priority.

“Although Raebel et al are correct in reporting that better pain management strategies are needed, they also may have uncovered an equally important problem — the need to know if, when, and how to safely and effectively taper or discontinue opioid therapy for patients with chronic pain,” Alford wrote.

For more information:

Alford DP. JAMA. 2013;310:1351-1352.

Raebel MA. JAMA. 2013;310:1369-1376.

Disclosure: Raebel reports grant and contract support from Agency for Healthcare Research and Quality (AHRQ) and the FDA. All other researchers report support from the AHRQ. See the study for a full list of disclosures.