Persistent Opioid Use Reported in 12 Percent Undergoing CIED Procedure

About 12 percent of patients who filled an opioid prescription within 14 days of cardiac implantable electronic device (CIED) procedures have persistent opioid use (POU), according to a study published online Nov. 15 in Circulation.

Timothy M. Markman, M.D., from the University of Pennsylvania in Philadelphia, and colleagues conducted a retrospective cohort study using data from a national administrative claims database of patients undergoing CIED procedures from 2004 to 2018. Adults were included if they were opioid-naive during 180 days before surgery.

The researchers found that 11 percent of the 143,400 patients who met the inclusion criteria filled an opioid prescription within 14 days of surgery. POU occurred in 12.4 percent of these patients at 30 to 180 days after surgery. An increased likelihood of developing POU was seen for patients with a history of drug abuse (odds ratio, 1.52), preoperative muscle relaxant or benzodiazepine use (odds ratios, 1.52 and 1.23, respectively), or opioid use in the previous five years (odds ratio, 1.76). There was no significant difference seen in POU after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.2 and 12.4 percent, respectively).

"Even a small number of oxycodones can start the addiction process," a coauthor said in a statement. "The significance of this study is to make other electrophysiologists aware that even a low-risk procedure like a pacemaker or a defibrillator can lead to chronic opioid use and that physicians may want to be more conservative in prescribing opioids after surgery."