Experts say healthcare professionals need to be aware of a person’s risk of opioid addiction before surgery is performed. blackCAT/Getty Images
  • Researchers say about 20 percent of people continue to use opioids 3 months after surgery.
  • Experts say pain medications are usually not necessary more than 3 months after an operation.
  • They say healthcare professionals as well as patients need to be better educated about potential risks of opioid addiction.

For postsurgical pain, few medications provide more relief than opioid-based pain relievers.

However, these medications have a high potential for misuse and addiction, and can be dangerous when use is continued beyond the point when they are needed to manage postsurgical pain.

A new study shows that the potential misuse of opioids prescribed for postsurgical pain is high enough to cause concern.

More than 1 in 5 “opioid naïve patients” — those who had not received another opioid prescription in the previous year — continued to use pain medications 3 months after having a surgical procedure, according to UCLA researchers.

People who smoke and people living with bipolar disorder, depression, or pulmonary hypertension were at the highest risk of continued use of opioid medications beyond the likely point of medical necessity, the research presented at the ANESTHESIOLOGY 2021 annual meeting found.

The research hasn’t been peer reviewed or published yet.

“We know that after surgical procedures, the longer the prescription, the higher the risk of chronic use” of opioids, said Dr. Charles Luther, a clinical assistant professor of psychiatry at Case Western Reserve University’s School of Medicine in Ohio, and chair and medical director of the Department of Psychiatry at Southwest General Health Center in Cleveland. 

Luther told Healthline that other studies have shown that the risk of addiction rises sharply after as little as 7 days of use of prescription opioid medication, from about 6 to 13 percent.

Education is crucial

Researchers said people who have not previously taken opioid medications may not be aware of their potential for misuse and addiction.

Luther said clinicians need to educate their patients about these risks, and patients have an obligation to learn about the potential and warning signs of opioid use disorder.

Opioid misuse may include taking more medication than the prescribed dose, continuing use past the point where pain has diminished, or taking medication for its psychological impact rather than to prevent physical pain.

“The more than 100 million surgeries in the U.S. every year create an unintended and alarming gateway to long-term opioid use,” said Dr. Gia Pittet, lead study author and a visiting graduate researcher for anesthesiology and perioperative medicine at UCLA. 

Pittet said the findings show that “the management of opioid administration during the postoperative period needs to extend well beyond the hospital stay,” including coordination between the patient’s surgical team and primary care physician.

Dr. Brian Wind, chief clinical officer of the addiction treatment program Journey Pure, told Healthline that past research has shown a link between the quantity of opioids prescribed for postsurgical pain and increased rates of addiction.

He noted that decreasing prescription quantities could reduce the risk of addiction.

“Patients may not be sufficiently educated on the addiction risks of opioids. Prescribers might be following default opioid prescription quantities, or even prescribing more for pain management,” Wind said.

“There may also not be enough work done with patients to gradually reduce doses until they don’t need opioids anymore, or not enough consideration of non-opioid pain management alternatives that are effective and centered around the needs of the patients,” he said.

Long-term use usually not necessary

Researchers studied the medical records of 13,970 opioid-naïve adults who had surgery at UCLA hospitals between 2013 and 2019.

They found that 21 percent of study participants refilled their opioid prescription 3 months to 1 year after the procedure.

Researchers noted that, except for people being treated for cancer and those who experienced chronic pain before surgery, few people should need to continue taking opioids more than 3 months after surgery.

Pittet said that after surgery, people should receive counseling about safe opioid use and education on alternative pain management choices. 

Luther added that some of those alternatives include exercise, acupuncture, yoga, tai chi, meditation, and biofeedback.

“We need to teach people how their mental state can affect their perception of pain,” he said.

People also should be closely monitored by their healthcare team while taking opioids, Pittet said.

“To reduce the likelihood of ongoing opioid use, physician anesthesiologists should use the preoperative assessment to identify patients at highest risk for persistent use,” Pittet said.

“Before they have surgery, patients who smoke should be encouraged to quit, those with pulmonary hypertension should see a doctor to help them get the condition under control, and patients with bipolar disorder or depression may require a preoperative adjustment of their medications,” she said.

Luther added that people with a family history of alcohol and other substance misuse also should be closely monitored after surgery, given that an estimated 40 percent risk of addiction has a genetic component.

“There’s a role for opioids. They can be a wonderful intervention, but they need be used in a time-limited fashion,” Luther said.

“Not all surgical interventions require an opioid prescription, but when they [do], there needs to be a clear conversation between the clinician and the patient about duration and dose and the factors that go into an opioid addiction,” he said.

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