Patients with bipolar disorder or depression are at increased risk of continuing to use opioids 3 months after surgery, according to research presented at the American Society of Anesthesiologists 2021 annual meeting.

The study, which looked at persistent opioid use among surgical patients who were previously opioid-naïve, found a much higher incidence than expected: overall, more than 1 in 5 surgical patients were still filling opioid prescriptions 3 months to up to 1 year after their procedure.

“The more than 100 million surgeries in the United States every year create an unintended and alarming gateway to long-term opioid use,” said study lead author Gia Pittet, AuD, PhD, a visiting graduate researcher for anesthesiology and perioperative medicine at the University of California, Los Angeles (UCLA). “Clearly the management of opioid administration during the postoperative period needs to extend well beyond the hospital stay, with better transfer of care to the primary care physician.”

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The study focused on 13,970 adults who had surgery at UCLA hospitals between 2013 and 2019. All patients included in the analysis were considered opioid-naïve at baseline, meaning they had not filled an opioid prescription 31 days to 1 year before surgery. (Researchers explained patients are often prescribed opioids ahead of surgery so the prescription can be filled and the medication available immediately after the procedure.)

According to the findings, 21.2% of patients continued to refill their opioid prescription 3 months to 1 year after surgery. Researchers pointed out that few patients should need opioids that long after surgery, unless they have cancer or had chronic pain before surgery.

When researchers considered risk factors, they found that patients who smoked or had a diagnosis of bipolar disorder, depression, or pulmonary hypertension were at increased risk of continued opioid use. Additionally, procedures involving cardiac and podiatry surgical providers or cataract surgery also raised the risk for persistent opioid use.

“Before they have surgery, patients who smoke should be encouraged to quit, those with pulmonary hypertension should see a doctor to help them get the condition under control, and patients with bipolar disorder or depression may require a preoperative adjustment of their medications,” Dr Pittet advised.

Reference

More than one in five opioid-naïve patients still use opioids three months after surgery. News release. American Society of Anesthesiologists; October 9, 2021. Accessed October 18, 2021.