Chronic opioid dependence use increases after surgery, researchers find

People who undergo various types of commonsurgeries are at an increased risk of becoming chronic users of opioid painkillers compared with other patients.

Many patients who haven't previously taken opioids such as morphine, fentanyl or oxycodoneare prescribed the pain medications after surgery. Opioid prescriptions have increased sharply in the past decade, particularly for noncancer pain, contributing to a crisis in the U.S. and Canada.

To find out how much surgery patients are at increased risk of taking the medication months after their procedure, researchers in California reviewed the records of more than 640,000 patients aged 18 to 64 who had 11 common operations and compared them to more than 18 million nonsurgical patients of similar age.

The patients in the surgical group had procedures such as hip and knee replacements, gall bladder removals, C-sections,appendix removals and sinus surgeries.

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Patients who didn't use an opioid before surgerywere at increased risk, the investigators said in Monday's issue of the journal JAMA Internal Medicine.

"The risks range fromabout 1 to five times depending on thesurgery," said study author Dr. Eric Sun of Stanford University School of Medicine.

"Overall,the risk is pretty low, it was about less than oneper cent for most of the surgeries we looked at," he added in a journal video.

Chronic opioid use was defined as having filled 10 or more more prescriptions or more than 120 days' supply of an opioid in the year after surgery, excluding the first 90 days after the operation, when use of painkillers is to be expected.

All of the surgeries were associated with an increased risk of chronic opioid use, except for cataract surgery, keyhole appendix removal, a sinus operation called functional endoscopicsinus surgery and transurethral prostate resection.

In general, men were more likely to be at increased risk than women, as were those 50 and older and people with a history of drug or alcohol abuse and use of benzodiapenes (often prescribed for anxiety) and antidepressants.

"Physiciansshouldclosely monitor their surgical patientsto see how much opioid they are or aren'ttakingandjust be aware that they may be at high risk for using opioids chronically," Sun suggested.

Non-drug options explored

In their paper, the authors said the resultsshould notbe taken as advocating that patients forgo surgery out of concernsfor chronic opioid use.

Canadian investigators have reported similar findings.

Some physicians are adopting alternativestoopioids, such as combinations of physiotherapy, meditation,acupuncture, andcounselling, among other techniques for painmanagement, forpatients who've had surgery.

The study's authors also listed use of regional anesthesiaas another suggestion, particularly for those at higher risk.

They acknowledged they couldn't account for allfactors that could affect the results, such as socioeconomic status.

Pain is often an indication for surgery. But they said even in the hip and knee replacements, the analysisconsidered patients whose pain wasn't enough to require chronic opioids before the procedure.