Opioids after low-pain surgery: study indicates higher risk of dependency

TORONTO - The prescribing of painkillers to seniors for relatively low-pain surgeries may lead to some becoming dependent on opioids such as codeine or oxycodone, a new study suggests.

The study, published Monday in the Archives of Internal Medicine, found that 7.1 per cent of patients were prescribed an opioid within seven days of these low-pain surgeries, and more than 10 per cent of them were using these potent pain medications a year later.

The research set out to explore why older adults would start taking a strong morphine-like drug and whether the medical system could possibly be contributing to chronic use.

"What we're trying to do is identify how some of the older people might start it, and the idea is that some of the people might start it by just having a casual interaction with the health-care system for a fairly self-limiting illness," said Dr. Chaim Bell, senior author of the paper.

"From a patient perspective, do you really need to take the most potent pain reliever, do you need to even take it or to fill it? That's a patient perspective. From a physician's perspective, or from a system perspective, we really need to do a better job of tailoring or focusing the surgery and the patient's pain requirements."

In the study, Bell and colleagues from the Toronto-based Institute for Clinical Evaluative Studies and St. Michael's Hospital, also in Toronto, reviewed Ontario health data for 391,139 patients aged 66 and over who had one of four identified low-pain surgical procedures in the period from 1997 to 2008.

All the study subjects were described as "opioid naive" they had not been prescribed opioids in the year before their surgery.

The procedures the researchers focused on were cataract surgery, gall bladder removal, surgery for benign enlargement of the prostate and varicose vein stripping. Bell said the four procedures are fairly low-pain and low-risk, and for most people, over-the-counter pain medication such as acetaminophen would probably suffice.

For the vast majority of these surgeries, the acute pain should have dissipated in the first couple of weeks, he said.

But a year after their surgery, 7.7 per cent of patients were being prescribed opioids. "More important, many individuals initially prescribed low-potency opioids had transitioned to more potent opioids, such as oxycodone, within one year of the surgery," the study said.

The rest is here:
Opioids after low-pain surgery: study indicates higher risk of dependency