A study, in the March 12 issue of JAMA’s Archives of Internal Medicine , reports that prescribing opioids for pain to older patients within seven days of short-stay surgery seems to be linked to the use of long-term analgesics, as compared with those who received no analgesic prescription after surgery.
Opioids like codeine and oxycodone, as well as nonsteriodal anti-inflammatory drugs (NSAIDS), are frequently prescribed to patients following ambulatory or short-stay surgery if the patient suffers from postoperative pain. In their background information, the researchers state that even though opioids can be of benefit, they are nevertheless linked to adverse effects, including sedation, constipation and respiratory depression and using these drugs over a long period of time can lead to physiologic tolerance and addiction.
Asim Alam, M.D., of the University of Toronto, Canada, and his team decided to assess whether a link exists between long-term analgesic use and prescribing analgesics to elderly patients after short-stay surgery. They indicate that elderly patients have a risk of adverse reactions to opioids.
They used population-based administrative data from Ontario in Canada, between April 97 to December 08, to identify patients aged 66 years and older who were given an opioid within seven days of short-stay surgeries, such as cataracts, varicose vein stripping, laparoscopic cholecystectomy (gallbladder removal) or transurethral resection of the prostate (prostate tissue removal).
The findings revealed 391,139 eligible patients who met the criteria and 27,636 (7.1%) of patients who received a new opioid prescription within seven days after hospital discharge following short-stay surgery, as well as 30,145 patients (7.7%) who were prescribed opioids one year after surgery.
They discovered that 2,857 or 10.3% of patients were long-term opioid users one year following surgery and remarked:
“After multivariate adjustment, patients receiving an opioid prescription within seven days of surgery were approximately 44 percent more likely than those who received no prescription to become long-term opioid users.”
The most commonly prescribed drug for those who received an early prescription was Codeine followed by oxycodone, the latter was noted to increase from 5.4% of being prescribed within seven days to 15.9% of prescriptions one year after surgery.
According to secondary analyses, those prescribed with early NSAID had a 3.7 times higher risk of becoming a long-term NSAID user, as compared with those who received no NSAID prescription within seven days of surgery.
In a concluding statement the researchers declare:
“Our findings suggest that the prescription of codeine after short-stay surgery may contribute to the use of other potent opioids, such as oxycodone, which have been shown to be associated with increased morbidity and mortality. These points do not even consider that the continued use of opioids after one year raises the possibility that the exposure may result in addiction or physical dependence.”
Beth D. Darnall, Ph.D., and Brett R. Stacey, M.D., of Oregon Health & Science University in Portland wrote in a comment:
“Epidemiological studies of pharmacy claims in the United States show that opioids are more likely to be prescribed to women than men and that women are more likely to be taking higher doses of opioids. Before initiating opioid treatment for chronic pain, in women or men, prescribers should fully assess the individual risks and benefits of the therapy and have a thorough discussion of the goals, risks and consequences of such therapy with each patient.”
A second comment by Mark D. Sullivan, M.D., Ph.D., and Jane C. Ballantyne, M.D., F.R.C.A, of the University of Washington School of Medicine in Seattle says:
“The collective clinical experience from 20 years of liberal opioid prescribing for chronic pain, together with the findings of recent population-based studies, suggests that LtOT (long-term opioid therapy) may benefit patients with severe suffering that has been refractory to other medical and psychological treatments but that is not often effective in achieving the goals originally envisaged, such as complete pain relief and functional restoration.”
The researchers conclude:
“This reframing of LtOT is a more honest appraisal of how it is actually used in practice. It would allow better patient selection and help to avoid the disastrous effects of promising more of opioids than they can achieve.”
Written by Petra Rattue