Large Opioid Rx After Heart, Lung Surgery Often Leads to Misuse: Study

The more opioid painkillers that heart and lung surgery patients are prescribed, the more likely they are to become dependent on them, a new study finds.

Researchers analyzed insurance claims from more than 24,500 Medicare patients who had heart or lung surgery between 2009 and 2015. Those patients filled an opioid prescription between 30 days before surgery and 14 days after leaving the hospital.

About 1 in 7 lung surgery patients (15.7%) and 1 in 8 heart surgery patients (12.5%) became new persistent opioid users for many months after surgery.

New persistent opioid users are patients who didn't take opioids before surgery, took them around the time of their operation and then continued to use them even after their recovery was complete, said study author Dr. Alexander Brescia, a resident in integrated cardiothoracic surgery at University of Michigan Medicine.

Patients who were prescribed more than 60 opioid pills had nearly twice the risk of chronic use than those who were prescribed 27 or fewer pills (19.6% vs. 10.4%).

The study was published online Aug. 22 in the The Annals of Thoracic Surgery.

"Our data show that patients undergoing heart and lung surgery are at a relatively high risk of developing persistent opioid use -- in some cases twice as high as after general surgery," Brescia said in a journal news release.

"This study also demonstrated that a higher prescription amount is associated with persistent opioid use three to six months after surgery, a time when patients should not still need opioid medication for postsurgical pain -- confirming that patients who are prescribed more opioids use more opioids," he added.

Other risk factors for opioid abuse included filling prescriptions before instead of after surgery; having open surgery; race; younger age; being female; economic status; tobacco use, and gastrointestinal complications.

Identifying these risk factors is "extremely important" in order to change prescribing practices, develop effective alternatives to manage pain, and combat the nationwide opioid crisis, according to Brescia.

"Patients should focus on pain management rather than pain elimination, and we have found that this can be achieved with far fewer pills than may be prescribed," he said.

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