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Patients with prior opiate prescriptions more likely to prolong use after trauma
If patients filled more than one opiate prescription prior to their injury, they were six times more likely to use opiates more than 12 weeks post-injury.
Trauma patients who use opiates pre-injury are at higher risk of using such prescriptions beyond 12 weeks post-injury and are more likely to seek these medications from other health care providers, according findings recently published in the Journal of Bone and Joint Surgery.
“We need to be aware of the mortality of these drugs and of the ubiquity of their use. Prescription opiate overdose is the second leading cause of accidental death in the United States,” Thomas F. Higgins, MD, associate professor at the University of Utah, Salt Lake City, told Orthopedics Today. A large number of patients who are already taking prescription opiates prior to their trauma will continue to take prescription opiates long after your treatment.”
Prescription opiate use
The researchers noted 15.5% of patients with orthopedic trauma had prescriptions for opiates filled 3 months prior to their injury compared to 9.2% of the general population of Utah. More than 12% of trauma patients had more than one opiate prescription filled before their injury compared to 6.4% of the general population.
Thomas F. Higgins
“Nine percent of the state takes prescription opiates, and that is indicative of the ubiquity of prescription opiate use in this country,” Higgins said.
The study encompassed 613 adult Utah residents who had a single hospitalization for traumatic fracture. The researchers obtained patient information using a database of all state residents on opiates. The minimum follow-up was 6 months.
Following surgery, the rate of prescription opiate cessation by trauma patients within 6 weeks post-injury was 68.4%, while 11.9% ceased use between 6 weeks and 12 weeks, and 19.7% had prescriptions for opiates written for them beyond 12 weeks.
Previous use signals future use
If patients used more than one opiate before their injury, they were six times more likely to continue opiate use beyond 12 weeks and were 3.5 times more likely to receive an opiate from a provider other than the treating surgeon. The risk factors for prolonged opiate use were advancing age and magnitude of use prior to injury,” Higgins said.
He added, “Orthopedic surgeons need to be aware of, and specifically ask their patients about, previous prescription narcotic use and it needs to factor into their thinking regarding postoperative pain management. There needs to be an increasing awareness of the rising tide of mortality from prescription opiates nationally.” – by Renee Blisard Buddle
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Disclosure: Higgins has no relevant financial disclosures.
Perspective
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The authors used an extremely creative way to study the issue of opiate use around the time of an orthopedic injury in a trauma service. The methodology has a significant number of drawbacks including the compliance in reporting by the state and the investigators’ selection of patients. The authors’ statement and conclusions are right on target. That 20% of the residents in Utah filled an opiate prescription during the 12 months prior to the study is fascinating and points to the widespread use and probable overprescription of opiates by all physicians. It is clear from the data presented that those who filled out prescriptions had opiates before surgery and had more problems after surgery. In particular, in chronic arthritis, practitioners would prescribe 60 percocets/month to patients with chronic arthritis pain. The pre-intervention use of opiates in patients with arthritis is a disservice to patients and society in general. This kind of work is of extreme importance to disseminate that concept and stimulate prospective studies.