Chronic opioid use contributes to the economic burden related to health care. Not much is known about what increases a person’s risk for opioid use or the potential risk factors for chronic use. Researchers have found that certain surgical procedures can increase the risk for narcotic pain medication usage.
The Opioid Abuse Epidemic
Pain relievers became plentiful in the 1990s, and during that time, drug overdose death rates in the United States grew. According to the Centers for Disease Control and Prevention (CDC), since the 90s, overdose deaths related to drugs have more than tripled. In America, 78 people die every day from opioid overdose.
According to the National Survey on Drug Use and Health (NSDUH), there were 137 million prescriptions of hydrocodone written in 2011 alone, and 5 million people in America admit to using opioid pain relievers. Of the users of pain medicine, 17% admit that they do not use the medicines for a medical purpose. The majority of overdose deaths occur in patients who are given prescriptions from their doctors, which are based on medical guidelines.
Results from a Recent Clinical Study
Researchers at Stanford University Medical School in California recently conducted a research study and found a link between common surgical procedures and increased use of opioid drugs. According to the study, patients who had never taken opioid pain relievers were at an increased risk for use of these drugs after surgery. Those who were at an increased risk for chronic use of narcotic pain medicine included:
- Older people
- Persons with a history of substance abuse or depression
According to the lead author of the study, Eric Sun MD PhD, the patients were not using opioids before their surgery, but after a year, many had become chronic users. The study was based on evaluation of over 640,000 opioid-naïve surgical patients and more than 18 million opioid-naïve nonsurgical patients. In the study, chronic opioid use was defined as filling 10 or more prescriptions or using a 120-day supply of pain medicine in the first year following surgery. For nonsurgical patients, chronic opioid use is filling 10 or more prescriptions of more than 120 days’ supply after the surgery date.
Surgeries associated with Chronic Opioid Use
There were 11 common surgeries associated with chronic opioid use:
- Total knee arthroplasty
- Total hip arthroplasty
- Laparoscopic cholecystectomy
- Open cholecystectomy
- Laparoscopic appendectomy
- Open appendectomy
- Functional endoscopic sinus surgery
- Cataract surgery
- Cesarean delivery
- Simple mastectomy
- Transurethral prostate resection
According to the recent study, the incidence of chronic opioid use ranged from 0.12% for cesarean delivery to 1.4% for total knee arthroplasty. The baseline increase incidence for nonsurgical patients was 0.14%. The authors also found that the patients were usually between the ages of 18 and 64 years of age. Odds ratios in the study ranged from 1.28 for Cesarean delivery to 5.10 for total knee arthroplasty.
- Medicaid enrollees receive pain medicine prescriptions at twice the rate of those persons without Medicaid.
- Around 80% of pain relievers are prescribe by 20% of doctors.
- Prescribed medicines account for most overdose incidence.
- Between 2000 and 2010, sales for opioids to hospitals, pharmacies, and doctors increased fourfold.
- In 2009, abuse of pain medicines accounted from 475,000 emergency department visits.
Center for Disease Control and Prevention (2016). Opioid drugs. Retrieved from: http://www.cdc.gov/drugoverdose/opioids/index.html
Manchikanti L, Helm S, Fellows B, et al. (2012). Opioid epidemic in the United States. Pain Physician, 15(3), 9-38.
Sun EC, Darnell B, Baker LC et al. (2015). Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period. JAMA Int Med. Published online July 11, 2016. doi:10.1001/jamainternmed.2016.3298