Ann Arbor, MI—A new study identifies a new risk factor for extended use of opioids: surgery, whether major or minor.

The article in JAMA Surgery points out that 6% of postsurgery patients were still using opioids prescribed for pain 3 to 6 months later, even though they hadn’t been using narcotics beforehand.

Researchers from the University of Michigan Institute for Healthcare Policy and Innovation note that the long-term opioid prescription–filling rate for those patients was 12 times higher than for a comparable group of adults who didn’t have surgery during the study period.

“This points to an under-recognized problem among surgical patients,” explained first author Chad Brummett, MD, director of the Pain Research division in the University of Michigan Medical School Department of Anesthesiology. “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.”

To determine the extent of the problem, the study team employed a nationwide insurance claims data set from 2013 to 2014 to identify U.S. adults, aged ≤64 years, who did not use opioids in the year prior to surgery.

The focus was on filling a perioperative opioid prescription, with 36,177 patients meeting the inclusion criteria. Most of them, 80%, received minor surgical procedures, with the remainder having major surgery.

The predominately white and female group had an average age of 45 years. Results indicate that, while rates of new, persistent opioid use were similar despite the type of surgery, ranging from 5.9% to 6.5%, the risk in the nonoperative control group was dramatically lower at 0.4%.

Preoperative tobacco use, alcohol and substance abuse disorders, mood disorders, anxiety, and preoperative pain disorders were all risk factors independently associated with new, persistent opioid use.

“These results show the need for education of surgical providers, to understand when it’s time to stop writing prescriptions for opioids, and to refer patients for assistance from a chronic pain physician,” Brummett, added.  “We need to be asking patients why they think they still need opioids, and what they’re being used for, not just refilling.”

The study authors conclude, “New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders. This suggests its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness.”

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