With the abuse of opioid painkillers a major public health threat in the United States, many worry that postsurgical use might trigger addiction. But a new study suggests that painkiller abuse is a problem in only a small fraction—less than one-half of one percent—of patients 66 years of age or older, according to a research letter published in JAMA Surgery.
Exposure to opioids is largely unavoidable after major surgery because they are routinely used to treat postoperative pain. Nevertheless, continued long-term opioid use can have negative health consequences, including opioid dependence. Limited data are available on the risk of previously opioid-naïve individuals developing persistent postoperative opioid use.
In a retrospective cohort study, researchers at Toronto Western Hospital in Ontario, Canada, tracked rates of opioid use for up to one year after major surgery among 39,140 patients. The study group included individuals who were 66 years of age or older; were opioid naïve (i.e., no prescription during the prior year); and underwent major elective surgeries (e.g., coronary artery bypass graft surgery via sternotomy; open and minimally invasive lung resection surgery; open and minimally invasive colon resection surgery; open and minimally invasive radical prostatectomy; and open and minimally invasive hysterectomy) from 2003 to 2010. The researchers measured the time to opioid cessation for patients receiving an opioid prescription within 90 days after surgery, with the date of cessation defined by the absence of an opioid prescription within the preceding 90 days.
Of the more than 39,000 opioid-naïve patients, 53% received one or more opioid prescriptions within 90 days after discharge. By one year after surgery, only 168 of 37,650 surviving patients (0.4%) continued to receive ongoing opioid prescriptions. The highest risk of long-term persistent opioid use occurred after lung-resection procedures.
The researchers write that their study “provides reassurance that the individual risk of long-term opioid use in opioid-naïve surgical patients is low. Conversely, the large volume of surgeries performed annually means that the population burden of long-term postoperative opioid use remains significant.”