As a nation ravaged by an opioid epidemic, much of the discussion is centered around how dosage leads to addiction, but a recent Harvard Medical School study published in the British Medical Journal suggests otherwise.
The study found among surgery patients with no history of recent or chronic opioid use, the length of time a person takes a medication is a much more accurate predictor of misuse than how much medication a person takes. “Misuse” is collectively defined as dependence, symptoms of abuse or nonfatal overdose.
So far, this is the largest study to investigate opioid misuse following surgery to date. The study analyzed a pool of more than 560,000 privately-insured surgery patients who were prescribed opioids after surgery between 2008 and 2016.
“We are in the midst of an epidemic, and physician prescription practices play no small part in it,” said Nathan Palmer, a biomedical informatics researcher at Harvard Medical School and the study’s senior investigator.
Previous research suggests that between 3% and 10% of patients who are prescribed opioids for the first time go on to become chronic users. Of this study’s 560,000 participants, 5,906 (0.6%) dealt with opioid misuse: dependence, symptoms of abuse, or nonfatal overdose.
One-third of misuse diagnoses occurred within a year of surgery, and for each additional week of opioid use, the risk for dependence, abuse or overdose increased by 20%. Each additional refill increased the risk by 44%, with the first refill more than doubling the risk.
“As physicians, we face a dilemma with each opioid prescription, so we need a more nuanced understanding of how to weigh the risks and benefits of opioid pain management immediately after surgery, including factors that influence misuse,” said Isaac Kohane, co-senior author on the study and head of the Department of Biomedical Informatics at Harvard Medical School. “These results provide much-needed clarity.”
Current guidelines for opioid pain management don’t address specific patient populations. This study emphasizes the need for healthcare professionals to be cognizant of the duration of treatment and the number of refills, and for surgeons to be more prompt to refer patients dealing with persistent pain to chronic pain specialists who can take context into consideration.
Prescription opioids can be a slippery slope toward a life of addiction, but recovery is possible. Boca Detox’s medically-assisted opiate detox is the safest first step on the journey to sobriety. Contact us at 561.271.7612 to learn more.