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New persistent opioid use after surgery common among adolescents

Calista M. Harbaugh

CHICAGO — Adolescents and young adults prescribed opioid pain medications after surgery commonly refill these prescriptions for months beyond typical recovery time, indicating a possible pathway to continued, nonmedical opioid use, according to findings presented at the American Academy of Pediatrics National Conference and Exhibition.

“The opioid epidemic is a significant public health problem that has affected all age groups in the U.S., including adolescents and young adults,” Calista M. Harbaugh, MD, a general surgery resident at the University of Michigan Medical School and pediatric surgery researcher at C.S. Mott Children’s Hospital and the Michigan Opioid Engagement Network, told Healio Internal Medicine.

Harbaugh and colleagues sought to evaluate the incidence of new persistent opioid use among privately insured opioid-naive adolescents aged 13 to 21 years who underwent one of 13 common surgeries between Jan. 1, 2010, and June 30, 2015 (n = 88,637; mean age, 17.1 years). The researchers compared these patients to a random sample of 3% of patients of similar age without procedural codes for opioid prescriptions. New persistent opioid use was defined as continued opioid prescription fills between 90 and 180 days after the index surgical procedure.

The researchers found that new persistent opioid use occurred in 4.8% of participants after surgery compared with 0.1% in the nonoperative control group. This incidence among the surgical cohort ranged across procedures from 2.7% to 15.2%, with those undergoing gallbladder removal (adjusted OR = 1.191; 95% CI, 1.062-1.335) or colon surgery (aOR = 2.753; 95% CI, 1.222-6.203) having the highest risk for new persistent opioid use. In addition, older age (aOR = 1.068; 95% CI, 1.054-1.082), female gender (aOR = 1.241; 95% CI, 1.160-1.329), higher comorbidity score (aOR = 1.015; 95% CI, 1.007-1.022), anxiety (aOR = 1.179; 95% CI, 1.004-1.384), and prior substance and drug use (aOR = 1.460; 95% CI, 1.163-1.833) were independently associated with new persistent opioid use.

“These findings present an opportunity for us to identify patients at the highest risk before surgery so that we can educate patients and parents on safe opioid use, prescribe appropriately and monitor following surgery,” Harbaugh said. “It is important for providers from all specialties to be aware of this possible complication so that communication and transitions of care are enhanced when prescription opioids are provided at the time of surgery.” – by Alaina Tedesco

Reference:

Harbaugh CM, et al. Persistent opioid usage among pediatric patients following surgery in the United States. Presented at: American Academy of Pediatrics National Conference and Exhibition; Sept. 16-19, 2017; Chicago.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.