Surgery leading to opioid risk


More than 13,000 Australians each year may be at risk of developing a persistent opioid habit following elective surgery, according to a BMJ study

New research has quantified the number of Australians that may be at risk of becoming chronic opioid users following surgery.

The study, published in BMJ Open this week, tracked 24,854 older Australian patients (median age 71 years) admitted for elective surgery between 2014 and 2015.

Results showed approximately 96.1% of the patient cohort had ceased opioid use by 90 days following surgery, while 3.9% of patients previously naïve to opioids went on to become chronic users, defined as more than 90 days of continuous therapy.

“Our results showed that 3.9% of patients discharged with opioids were still on them after one year,” says Dr Renly Lim, from UniSA’s Quality Use of Medicines and Pharmacy Research Centre.

“More than 2.2 million Australians undergo elective surgery every year, around 15% of whom are discharged with opioid prescriptions.

“This means around 13,000 people may transition to become chronic opioid users, and, as the number of surgeries performed annually is increasing, the numbers of people continuing opioids post-discharge is likely to increase.”

Patients were most frequently discharged with oxycodone (predominantly the 5 mg strength in packs of 20), which alone accounted for 43% of cases, while oxycodone with naloxone accounted for 8%.

Codeine with paracetamol was the opioid dispensed on discharge for 37% (most frequently in a pack of 20 tablets), while tramadol accounted for 10% (most frequently in a pack of 20 tablets).

The findings are consistent with similar studies conducted in North America, and Dr Lim says they indicate a need for greater recognition of the risks of post-surgery opioid use and the implementation of more robust patient support during recovery.

“There is a need to mitigate the risk of chronic opioid use following hospital discharge and to achieve this, we first need to make sure healthcare professionals are aware of this problem.

“For patients discharged on opioids there should be a clear discontinuation plan which is communicated to the patients and the health care team, and then patients should be actively followed up to reduce the risk of transitioning to chronic opioid use,” Dr Lim says.

The study also found the pattern of persistent opioid use post-discharge was not uniform across all types of surgery, with patients undergoing some form of orthopaedic intervention most at risk.

“This is not surprising since orthopaedic surgeries are often painful procedures and can require pain-relief for acute post-surgery pain,” Dr Lim says.

Admissions where the primary diagnosis was associated with injury and other consequences due to external causes were the group with the highest proportion continuing opioids beyond 90 days.

See the full article in in BMJ Open.

You may be interested in reading: Forced tapering and cessation: opioid consequences

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