If You’re Prescribed Opioids after Injury or Surgery, Will You Become Dependent?
We’ve all seen the massive media attention on the opioid epidemic and as the dust settles and changes are made to how opioids are viewed, we are left with a few takeaways. One of them is that if someone is injured or has had surgery, prescribing opioids is a bad thing because many will become dependent.
A new study presented at the American College of Surgeons refutes this notion, reporting that up to one year after discharge from the hospital, only about 1 percent of trauma patients were reportedly still taking prescription opiates, or opioids, such as hydrocodone, oxycodone, morphine, and fentanyl.
“Our findings in patients who sustain traumatic injury contradict the popular narrative about the role that appropriate use of opioids may play in the rate of opioid abuse in this country,” said senior investigator Andrew Schoenfeld, MD, an orthopaedic surgeon at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, Boston.
This new study is one of the largest investigations of prescription opiate use among patients who sustained trauma and may have the longest continued follow-up one year after hospital discharge.
Their research was conducted using the 2007 to 2013 database of TRICARE, the Department of Defense health care system that insures active-duty military, reserve members, retired veterans, and their dependents. Because most TRICARE plan members are currently civilians, Dr. Schoenfeld said the study findings are generalizable to the U.S. population.
Included in the study were patients aged 18 to 64 years whose injuries were severe, as indicated by an Injury Severity Score of 9 or higher. Patients with major trauma could be expected to receive opiate prescriptions after their hospitalization. In all, 15,369 patients were included and none of the patients had filled an opiate prescription within six months before their injuries.
Although more than half of the patients in the study, or 8,282, filled at least one opiate prescription soon after discharge, only 8.9 percent (1,371 patients) continued to fill opiate prescriptions three months later, the investigators reported. Continued prescription opiate use reportedly dropped to 3.9 percent (597 patients) at six months and 1.1 percent (175 patients) at one year.
“We were really surprised by how low the numbers were for long-term opiate use,” Dr. Schoenfeld said. “It appears that traumatic injury is not a main driver for continued opioid use in patients who were not taking opioids prior to their injuries.”
To identify predictors of continuing use of prescription opiates after hospital discharge, the researchers evaluated patients’ demographic and medical factors and found increased risk of continued opioid use among the following:
- Patients ages 45 to 64 compared to those 18 to 24.
- Lower socioeconomic status
- Those who are married (although these finding probably cannot be generalized to the U.S. population, according to Dr. Schoenfeld, because military families tend to marry earlier than civilians do.)
“We wish to emphasize that health care providers should not withhold opiate painkillers because a patient has any of the identified risk factors from this study,” Dr. Schoenfeld said. “At-risk patients can benefit from closer follow-up with their health care providers and, for those at high risk, a referral to the hospital’s pain management service.”
The study results were presented at the 2016 Clinical Congress of the American College of Surgeons.
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