Post-Lung Surgery Opioid Prescriptions May Lead to Dependency

Opioids are intended to be a short-term treatment for pain following surgery, but many patients who undergo lung surgery become dependent, continuing opioid use for months after surgery.

According to a study presented at the 54^th Annual Meeting of the Society of Thoracic Surgeons, 1 in 7 patients who underwent lung surgery have become new persistent opioid users.

The authors defined new persistent opioid users as patients who had not previously taken opioids, underwent surgery, were prescribed opioids to relieve post-surgical pain, and continued taking opioids after they had recovered from surgery.

The investigators examined data from insurance claims of more than 100 different health plans between 2010 and 2014. The researchers found that 3026 patients who underwent lung resection surgery had not previously taken opioids. Notably, 1 in 7 of these patients became dependent on opioids after undergoing surgery.

Patients were nearly twice as likely to develop opioid dependence if they underwent an open surgery with a large incision rather than a minimally invasive procedure, according to the study. Additionally, 17% of patients who had open lung surgery were likely to become opioid dependent, compared with only 9% of patients who had minimally invasive procedures.

Other patients at a higher risk of opioid dependency were males, those younger than 64, those with an income of less than $70,000, those with a history of substance abuse, those with a hospital stay longer than 5 days, and those receiving post-operative chemotherapy/radiation treatments, according to the study.

Researchers suggest that health care providers educate patients regarding the risks associated with opioid use and offer alternative methods for pain management.

“It is vitally important to discuss pain management with your surgeon and other health care providers prior to surgery,” said study author Alexander A. Brescia, MD. “Taking opioids for pain following an operation could put patients at risk of becoming dependent or addicted to these medications. Together with their surgeons, patients should develop a plan to appropriately manage their pain while also minimizing their risk of taking these medications for longer than intended after surgery.”

According to the CDC, opioid prescriptions were at an all-time high in 2012, with more than 255 million prescriptions and a rate of 81.3 prescriptions for every 100 people. These rates have declined but opioid use still remains high in the United States, with 214 million prescriptions dispensed in 2016.

The high number of prescriptions is significant because prescription opioids play a role in 40% of opioid overdose deaths, according to CDC data. The study authors call on surgeons to be more cautious when prescribing opioids after surgery.

“Surgeons are at the forefront of the opioid crisis as the main prescribers of these medications following surgery,” Dr Brescia said. “Our research attaches data to this epidemic and hopefully provides a clear characterization of the issue and highlights ways to combat the crisis, with important roles for both surgeons and patients.”