What leads to opioid misuse?

In a recent study, researchers find the risk factors that place patients at an increased chance of prolonged opioid use.

The study was conducted by Beth Israel Deaconess Medical Center (BIDMC).

An estimated 2.1 million Americans are reported to have an opioid use disorder linked to prescription medications.

This accounts for half of all opioid-related deaths in the United States.

Each year about 234 million patients undergo major surgeries. Surgeons realize that they have to balance the need for pain management against patients’ risk of opioid abuse.

Previous research has shown that patients’ exposure to opioids following medical care has contributed to the nationwide addiction epidemic.

In the study, the team analyzed findings from 37 studies with nearly 2 million participants. The overall rate of prolonged opioid use among participants was less than 5%.

They found that certain prescribing patterns, surgical procedures and patient characteristics increase patients’ risk of long-term opioid use following surgery or trauma.

They demonstrated that prior use of prescribed opioids or benzodiazepines, depression and back pain were among the most important patient-related factors for opioid use beyond two months.

While depression and chronic pain were significant risk factors, the use of antidepressants or non-narcotic pain killers did not appear to increase the patients’ prolonged use of opioids.

The team also notes that physicians’ prescribing practices can influence the incidence of prolonged opioid use.

Long-term opioid use is much higher among patients treated by high-intensity prescribers than among those treated by low-intensity prescribers.

Physicians also tend to prescribe opioids to women more often than men.

Doctors may also avoid the use of non-steroidal anti-inflammatory drugs such as ibuprofen in patients with cardiovascular concerns, opting for opioid analgesics instead.

These prescribing practices may explain why gender and cardiovascular health are significant risk factors for prolonged opioid use.

On the other hand, providing patients with adequate pain relief, involving patients in pain management planning with realistic goal-setting and providing them with comprehensible information about the risks of opioid use, tapering opioid use prior to hospital discharge and using more uniform prescribing protocols could reduce the overall burden of long-term opioid use following surgery or trauma.

Overall, their study suggests much more effort is needed in order to mitigate the problem of prolonged opioid use.

Study author Ara Nazarian, Ph.D. is a principal investigator in the Center for Advanced Orthopaedic Studies at BIDMC and Associate Professor of Orthopaedic Surgery at Harvard Medical School.

Corresponding author Amin Mohamadi, MD, MPH is a post-doctoral research fellow in the Nazarian lab.

The study is published in the Journal of Bone and Joint Surgery.

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