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Opioid misuse after surgery low, increases with extended duration

Although overall postoperative misuse of opioids was low, refills and longer durations of prescriptions increased the risk for abuse, according to findings published in the BMJ.

“The lack of guidance around postsurgical opioid prescribing partially results from little being known about the effect of longer and larger regimens of postdischarge opioids,” Gabriel A. Brat, MD, from the department of biomedical informatics at Harvard Medical School, and colleagues wrote. “More directly, it is not known how prescription refills affect the long-term likelihood of misusing opioids.”

Brat and colleagues conducted a retrospective cohort study to evaluate how different opioid prescribing patterns after surgery influence dependence, overdose or abuse in opioid-naive patients. The researchers used surgical claims from a medical and pharmacy administrative database of patients commercially insured between 2008 and 2016 to identify 1,015,116 opioid-naive patients undergoing surgery.

Data showed that postoperative opioids were prescribed to 56% of participants and abuse was observed in 0.6% of participants. The strongest predictor of misuse was the total duration of use, rather that dose. Specifically, there was a 44% adjusted increase in the rate of misuse for each refill and a 19.9% increase for each additional week of opioid use.

“Our findings are important as they offer a potential lever for intervention and behavior change after surgery,” Brat and colleagues concluded. “Given that surgical and nonsurgical patients receive similar numbers of opioid refills, these findings have the potential to extend beyond surgery.

“Clinicians are trapped between guidelines that recommend shorter duration and lower dosing of opioid drugs and a subset of patients who request or require opioids beyond the initial prescription. With these seemingly conflicting forces at play, our analysis provides a broad evidentiary framework to inform clinician behavior and promote protocol development. Further research of this relation is needed to determine how initial treatment regimens can minimize misuse and addiction.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.