Patients prescribed opioids within a week of surgery 44% more likely to become chronic users

Patients who are being prescribed a strong opioid (morphine-like drug) within seven days of relatively low pain surgery (cataract surgery, laparoscopic cholecystectomy, transurethral resection of the prostate or varicose vein stripping) are at risk of becoming a chronic user of the drug.

These are patients who were not using opioids before surgery and likely didn’t require the powerful painkillers for long after surgery, according to a new study by researchers at the Institute for Clinical Evaluative Studies (ICES) and St. Michael’s Hospital.

“Current opioid use is at epidemic proportions. Patients are often prescribed opioids after ambulatory and short-stay surgeries preemptively in anticipation of post-operative pain. And in many cases, patients are given a standard dose based on the expectation of post-operative pain. However, it is likely that some of these patients did not need the prescription in the first place,” says Dr. Chaim Bell, the senior researcher.

Dr. Bell examined data for 391,139 opioid-naïve patients undergoing short-stay surgery between April 1, 1997 and December 31, 2008. Opioids were newly prescribed to 27,636 (7.1 per cent) patients within seven days of being discharged from hospital and 30,145 (7.7 per cent) patients were prescribed opioids at one year from surgery. There was an increase in the use of oxycodone over this time (from 5.4 per cent within seven days to 15.9 per cent at one year).

“Long-term post-operative analgesic use may best be addressed by preventing its initiation,” adds Dr. Bell. “A reasonable approach includes clinicians and patients frequently reassessing the adequacy of pain control and the indication for opioids.”

Dr. Bell found that patients receiving an opioid prescription within seven days of surgery were 44 per cent more likely to become chronic opioid users within one year, as compared with those who received no such prescription. The concern is that some patients become chronically dependent on a powerful painkiller they never needed in the first place.

Author Block: Asim Alam, Tara Gomes, Hong Zheng, Muhammad M. Mamdani, David N. Juurlink and Chaim M. Bell.

The study “Long-term analgesic use following low-risk surgery: A retrospective cohort study,” is in the March 12, 2012 edition of Archives of Internal Medicine.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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