Health News

Risk for chronic opioid use low in older surgical patients

Most patients prescribed opioid-based painkillers to treat pain after surgery are at higher risk for chronic use and longer-term abuse, but researchers say that may not be true for older surgical patients.

Surgical patients older than than 66 are at very low risk for chronic use of opioids a year after surgery, according to a study published in the journal JAMA Surgery.

Researchers at Toronto General Hospital found just over half of patients received opioid prescriptions three months after surgery, and 0.4 percent were still using the drugs one year after surgery, suggesting most older patients don’t need the drugs for extended periods of time and do not develop problems with use.

The study would seem to contradict a July study by researchers at Stanford University, also published in JAMA Surgery, which found certain common surgeries had significantly higher risk of chronic use of the drugs. Chronic use was defined as 10 or more prescriptions or more than a 120-day supply within the first year after surgery, not including the 90 days after surgery.

While the study at Stanford found higher risk depending on the surgery, and researchers suggested older patients could be at greater risk for chronic use, participants in the study were between the ages of 18 and 64 — younger than the new study from Toronto General Hospital.

The new study, as well as closer readings of previous research on opioid use, overuse and misuse, suggests problems with the drugs may be overblown because of confusion between monitored treatment and the addiction problems that have plagued many countries, including the United States.

“It’s often younger patients that are associated with persistent opioid use,” Dr. Hance Clarke, an anesthesiologist and director of the Pain Research Unit at Toronto General Hospital, told UPI in a phone interview. “There are specific groups that are at higher risk [for chronic use and abuse], but overall the concern has been sensationalized because of the opioid crisis.”

In a 2014 study, researchers at Toronto General found 3 percent of patients 66 years or older who had major elective surgery between 2003 and 2010 were still using opioid drugs for pain 90 days after a surgical procedure.

For the new study, the researchers analyzed medical data on the same 39,140 opioid-naive patients from the previous study during their first year after surgery.

Of the patients, 53 percent received one or more opioid prescriptions within 90 days of discharge from the hospital. Of these, just 168 of the 37,650 surviving patients — 0.4 percent — continued to receive prescriptions for an opioid.

Clarke said about 70 percent of surgical patients are prescribed opioid-based painkillers and most patients who continue to receive prescriptions for the drugs have a pain problem, not an addiction. Patients who have hip or knee replacement surgery, for example, are often kept on opioid painkillers for longer periods of time based on pain associated with recovery, as shown in a recent study by the University of Michigan.

While he notes the potential for developing tolerance or dependence on the drugs, opioid-naive patients — those who have rarely or never been prescribed the drugs and do not have previous drug problems — can safely use them medically and not develop issues.

There are patients with higher potential for developing problems, Clarke said, but studies have shown they can be identified and doctors must be vigilant and attentive to patients with the potential for a problem, especially if chronic opioid use is the proper path for treatment.

“The one thing that is most important here is the outlier patients,” Clarke said. “A portion of patients do horribly and develop a problem. So, if you have a history of depression or drug abuse, those are [people] who we’re concerned about. Those are risk factors for addiction.”