Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study

Abstract

ObjectiveTo quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population.DesignRetrospective cohort study.SettingSurgical claims from a linked medical and pharmacy administrative database of 37 651 619 commercially insured patients between 2008 and 2016.Participants1 015 116 opioid naive patients undergoing surgery.Main outcome measuresUse of oral opioids after discharge as defined by refills and total dosage and duration of use. The primary outcome was a composite of misuse identified by a diagnostic code for opioid dependence, abuse, or overdose.Results568 612 (56.0%) patients received postoperative opioids, and a code for abuse was identified for 5906 patients (0.6%, 183 per 100 000 person years). Total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with an adjusted increase in the rate of misuse of 44.0% (95% confidence interval 40.8% to 47.2%, P<0.001), and 19.9% increase in hazard (18.5% to 21.4%, P<0.001), respectively.ConclusionsEach refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period. The analysis quantifies the association of prescribing choices on opioid misuse and identifies levers for possible impact.

Trends in patient procurement of postoperative opioids and route of hysterectomy in the United States from 2004 through 2014

“…Brat et al utilized the Aetna health and pharmacy insurance claims database to describe opioid trends from 2008 to 2016 for general surgery procedures. The percentage of patients filling their opioid prescriptions increased from 47.9% in 2008 to 63.9% in 2013 [26]. Results from other surgical procedures report that in the years later than those included in this study (2012–2017), greater than 2/3 of patients filled their opioid prescriptions after discharge [27, 28].…”

Tramadol use in Norway: A register‐based population study

“…Additionally, current studies have investigated the risk of opioid misuse and pain relief among opioid naïve CNCP patients, and their conclusions do not support initiating of opioid therapy for CNCP. Association between each refill and week of opioid use with large increases in opioid misuse was found, as well as a less effective pain‐related function over 12 months using opioids compared with non‐opioid medication . It is relevant to question whether it is the appropriate patient population, who receive long‐term opioid treatment for CNCP since a substantial number of patients' pharmacological treatment conflicts with guideline recommendations …”

Risiko for opioidmisbruk etter kirurgi

“…Hvor stor er risikoen etter kirurgi? En amerikansk registerstudie, som nylig er publisert i tidsskriftet BMJ, omfattet over en million mennesker som hadde gjennomgått et kirurgisk inngrep (1). Kun pasienter som hadde brukt opioide legemidler i faerre enn åtte dager de siste to månedene, ble inkludert, og pasienter med tidligere opioidavhengighet ble ekskludert.…”