Opioid naive individuals at low risk of developing persistent opioid use after surgery, research shows

Researchers from the University Health Network's Department of Anesthesia and Pain Management and the Institute for Clinical Evaluative Sciences (ICES) have determined that patients who have not had an opioid prescription within a year prior to their procedure are at low risk of developing persistent opioid use after major surgery.

The research, published July 6 in the Journal of the American Medical Association - Surgery, showed that of the 39,140 observed patients only 0.4 per cent - approximately one in every 225 patients - continued to receive ongoing opioid therapy one year after undergoing major elective surgery.

"As opioid use has grown in society, it has become an important healthcare issue. Patients and physicians are increasingly concerned about the risks of opioid exposure during and after surgery," says Dr. Neilesh Soneji, Staff Anesthesiologist, Toronto Western Hospital and the lead author of the study. "However, these findings provide reassurance that the current strategies to manage acute pain after surgery are associated with a low risk of persistent opioid use in our study population. This empowers clinicians to address patients' concerns about the risk of developing long term opioid use after major surgery."

The researchers conducted a retrospective analysis of anonymized population-based healthcare data securely housed at ICES, the Institute for Clinical Evaluative Sciences (ICES), the research is based on a retrospective analysis of anonymized population-based healthcare data which including databases on outpatient prescriptions dispensed to Ontario residents aged 65 years or older.

For this study, researchers focused on individuals who were aged 66 years or older, were not previously taking opioid medications, and underwent one of the following operations between 2003 and 2010: heart bypass surgery, major lung surgery, major abdominal surgery, major prostate surgery, and major surgery on the uterus. They then looked at the number of individuals who had continued to receive repeated prescriptions for opioids at least every 90 days for the next year after surgery.

The analysis determined that of the 39,140 patients in this cohort, 53 per cent received one or more opioid prescriptions within 90 days of their surgery but, by the 365 day mark, only 0.4 per cent continued to receive prescriptions. The study also showed that patients who underwent major lung surgery were at highest risk of persistent opioid use a year after surgery.

"These findings are important because they show that an opioid naive individual has a low risk of developing persistent opioid use after surgery," said Dr. Hance Clarke, Medical Director, Pain Research Unit and Director, Transitional Pain Service, Anesthesia Department and Pain Management, Toronto General Hospital. "This means future research and interventions should be targeted towards better identifying patients who are at higher risk of developing persistent opioid use and providing them with adequate resources."

In previous research on opioid use after surgery in Ontario residents, Dr. Clarke and team previously found at-risk patients are those who have pre-existing pain, mental health issues, chronic preoperative use of opioids, and those who do not have access to teams who specialize in advanced and multiple techniques of pain management.

The Transitional Pain Team at Toronto General Hospital uses a variety of methods to help and teach patients to manage their pain. These include prescribing non-opioid medications, use of psychological techniques such as mindfulness or moment-by-moment awareness of our thoughts and sensations, as well as "exercise prescriptions" and acupuncture by a healthcare team of medical pain specialists, pain nurse practitioners, a psychologist and physiotherapists.