Bariatric Surgery Places Patients at Risk of Long-term Opioid Use

After surgery, a majority of patients may receive an opioid prescription to manage pain. In light of the opioid epidemic, some healthcare providers are evaluating the appropriateness of the prescriptions to determine whether post-surgical opioid use can increase the risk of opioid abuse.

A new study presented at the American College of Surgeons Clinical Congress 2017 indicates that approximately 1 in 12 patients who did not take opioids until their bariatric surgery was performed, or a month prior to the procedure, are still using the drugs 1 year post-operatively.

Notably, the authors found that the rate of new long-term users of opioids was 46% higher among patients who received bariatric surgery compared with general surgical patients, according to the study.

The authors said these findings suggest that certain populations may be more prone to long-term opioid use.

“Surgeons must identify patients who may be at higher risk for addiction to opioids, so they can adjust prescribing for postoperative pain,” said senior investigator Amir A. Ghaferi, MD, MS, FACS, FASMBS. “Patients undergoing bariatric surgery may be particularly vulnerable to opioid dependence, possibly because of chronic knee and back pain associated with morbid obesity.”

In 2015, approximately 196,000 patients underwent bariatric surgery. Understanding the rate of persistent opioid use after this surgery can play an important role in reducing the effects of the opioid epidemic, according to the authors.

Included in the study were 14,063 patients who underwent bariatric surgery and responded to questions about prescription painkiller use before and after the operation.

The authors discovered that patients who underwent bariatric surgery typically receive an opioid prescription, with most patients discontinuing use within 2 weeks. However, the authors also found that a small portion of patients continued the therapy for an extended period of time.

Approximately 73% of patients reported not taking opioids 1 month to 12 months before surgery. Of these patients, 8.8% were still using opioids 1 year after their operation, according to the study.

The prevalence of new persistent opioid use was 46% higher than the 6% rate for the general surgical populations, according to the study.

Overall, 1 in 4 patients were still taking opioids at 1 year after bariatric surgery.

“Given the known elevated risk of cross-addiction to alcohol and illicit drugs in bariatric surgical patients, providers should pay special attention to opioid use during the postsurgical period,” Dr Ghaferi said.

The authors advise that patients should be informed that they do not need to finish the opioid prescription if they are no longer in pain and should consider managing pain with ibuprofen or acetaminophen.

Based on the findings, the authors suggest that providers screen patients for substance use risk factors, prescribe short-term opioid therapy, and perform local nerve blocks during surgery to reduce the need for opioids, according to the study.

The authors said that additional studies are needed to determine effective screening methods for opioid misuse and to determine appropriate prescription length.

“We don’t want our surgical patients to become addicted to opioids, but of course we don’t want them to be recovering at home in pain either,” Dr Ghaferi said.