Research Suggests Changes to the Way Opioids Are Prescribed after Surgery Could Prevent Misuse

A team of researchers from Harvard Medical School in Boston has published a new study suggesting changes to the way opioids are prescribed after surgery could be a way to reduce misuse.

Featured in the British Medical Journal, the study Postsurgical Prescriptions for Opioid Naive Patients and Association with Overdose and Misuse: Retrospective Cohort Study was released in January 2018.

Opioids are often prescribed to patients to manage pain following surgery. Current practice recommends prescribing low doses for a short period of time to prevent the issues which can arise from long term use. Despite this, on a global scale opioid misuse is increasing and overprescribing is thought to be a contributing factor. The US is the world's biggest opioid prescriber and also has the highest prevalence of opioid prescription misuse giving impetus for a better understanding of opioid misuse and the link to post-surgery prescribing.

The US based team set out to examine the association between opioid prescription refills (repeat prescriptions) after surgery and misuse. Implementing administrative data to track prescription refills for oral opioids after discharge the team then used diagnostic coding data to identify opioid dependence, abuse or overdose.

In the study, which focused on individuals who had undergone routine surgery between 2008 and 2016, the team were able to identify that overall rates of misuse were low – 0.06% - within the population but increased with each prescription refill.

Each opioid prescription refill was associated with a 44% increase in misuse and each additional week of opioid use was associated with a 20% increase in opioid misuse among these patients. This led researchers to understand that risk of misuse was related to the duration of treatment rather than the dose administered. They discovered that where the duration of treatment was short high doses of opioids were linked to a minimal increase in misuse.

It is important to note that this is an observational study with a large sample. While firm conclusions about cause and effect cannot be determined the research team were able to account for a broad range of influential factors which could “inform protocol development”.