Study highlights need to establish clinical practice guidelines for surgical patients receiving MOUDs

In an effort to stem the death toll from opioid overdose, United States public health officials have promoted the prescription and use of medications like buprenorphine that blunt the effects of illicit opioids such as fentanyl.

However, what happens when patients on these medications require surgery and anesthesia?

Currently, there are no evidence-based guidelines to help clinicians handle this patient population.

To fill in knowledge gaps, Mark Bicket, M.D., Ph.D., and his team examined trends in use of medications for opioid use disorder among surgical patients.

The results are published in the journal Anesthesiology.

Looking at 2016-2022 claims data from the Merative MarketScan Commercial Database, the team focused on surgeries amongst adults 18-64 who had a claim for buprenorphine, methadone or extended-release naltrexone (together categorized as MOUD, medications for opioid use disorder) between 1 and 180 days before their procedure.

They found that rates of MOUD use went up from 154 per 100,000 procedures in 2016 to 240 per 100,000 procedures in 2022, mostly resulting from increases in the use of buprenorphine.

The prevalence of MOUD use increased in all age subgroups except in patients 18-34, which slightly decreased.

As for types of surgeries undergone by these patients, debridement and orthopedic procedures, such as shoulder arthroplasty, lower extremity amputation and hip or pelvis fracture open repair had the highest prevalence of MOUD use.

The findings highlight a need to establish clinical practice guidelines for patients receiving MOUDs, especially around orthopedic surgery, to coordinate care and pain management and mitigate risk of harm.