Doctors are prescribing more than four times the number of opioids necessary after surgery
While there are several issues believed to be contributing to America’s ongoing opioid epidemic, new research suggests one of the biggest factors could be that doctors are overprescribing painkillers after surgery.
A study published in JAMA Surgery says that many surgeons are giving more than four times the necessary number of opioids to patients after surgery. This is particularly dangerous as the findings also indicate that the risk for abuse and over-use of pills increases with the number of pills given, regardless of pain score or intensity of the surgical procedure.
“It was great to see the results confirming what we had suspected — that if you prescribe more pills to patients, they take more, regardless of their pain or other factors,” says Joceline Vu, MD, senior author of the new paper and a surgical resident and research fellow at Michigan Medicine, University of Michigan’s academic medical center. “This means that pain isn’t the primary driver of how much patients take after surgery.”
To come to this conclusion, the team of researchers reviewed data collected from nearly 2,400 patients who had undergone one of 12 common surgical procedures within 33 different hospitals across Michigan in 2017.
According to the team, patients only used 27% of the opioids they were prescribed, on average. With every 10 additional pills prescribed, the number of pills taken increased by approximately 5.
“One of the biggest reasons we’re overprescribing, especially after surgery, is because we just don’t really know how many pills patients actually needed,” says Dr. Vu. “Couple that with a desire to satisfy patients and you have an incentive to write more pills just in case they need them.”
If the number of pills taken was directly related to the severity of the surgical procedure, the increase could be attributed to increased pain and medical needs. However, that wasn’t the case. Instead, the study found that the biggest predictor of the number of pills taken was the size of the prescription.
Other factors that were linked to increased use of opioids after surgery included age, tobacco use, and those who underwent inpatient operations.
Patients who underwent hernia repair surgery took the most opioids on average, while those that had their appendix or thyroid removed took the fewest number of pills.
While the team accounted for a number of factors, they say they were unable to receive background medical information, particularly about mental health or pre-surgery drug use, which are both linked to increased rates of prolonged opioid use.
Still, Vu and her team believe the findings should raise concern about prescribing rates, as many patients view prescriptions as “safe”.
“Prescription opioids are as addictive as their related drug heroin, and they’re a much easier gateway to addiction and the eventual switch to intravenous drugs,” says Vu.
The easiest way to address the problem is “simply prescribing less” as Vu explains. “Especially since we know patients need much less than we give them.”
“It’s not the only solution though; we do cause legitimate pain when we perform surgery, and we have to make sure we are adequately treating patients’ pain.”
“We should also try to use nonopioid medications as much as possible; often these can be even more effective for pain and they don’t have the same risks of addiction,” says Vu. “We should think of these medications as dangerous substances, and check on our patients. If they’re done taking them, we need to encourage our patients to dispose of them safely and make it easy to do so.”