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Observational Study
. 2021 Apr 1;273(4):743-750.
doi: 10.1097/SLA.0000000000003549.

Postsurgical Opioid Prescriptions and Risk of Long-term Use: An Observational Cohort Study Across the United States

Jessica C Young  1 , Nabarun Dasgupta  2 , Brooke A Chidgey  3 , Michele Jonsson Funk  1
Affiliations
Observational Study

Postsurgical Opioid Prescriptions and Risk of Long-term Use: An Observational Cohort Study Across the United States

Jessica C Young et al. Ann Surg. .

Abstract

Objective: The aim of this study was to evaluate differences in risk of long-term opioid therapy after surgery among an opioid-naive population using varying cutoffs based on days supplied (DS), total morphine milligram equivalents (MME) dispensed, and quantity of pills (QTY) dispensed.

Background: In response to the US opioid crisis, opioid prescription (Rx) limits have been implemented on a state-by-state basis beginning in 2016. However, there is limited evidence informing appropriate prescribing limits, and the effect of these policies on long-term opioid therapy.

Methods: Using the MarketScan claims databases, we identified all opioid-naive patients undergoing outpatient surgery between July 1, 2006 and June 30, 2015. We identified the initial postsurgical opioid prescribed, examining the DS, total MME, and QTY dispensed. We used Poisson to estimate adjusted risk differences and risk ratios of long-term opioid use comparing those receiving larger versus smaller volume of opioids.

Results: We identified 5,148,485 opioid-naive surgical patients. Overall, 55.5% received an opioid for postoperative pain, with median days supply = 5 and median total MME = 240. The proportion of patients receiving prescriptions above 7 DS increased from 11% in 2006 to 19% in 2015. Among those receiving postoperative opioids, 8% had long-term opioid use, and risk of long-term use was 1.16 times [95% confidence interval (CI), 1.10-1.25] higher among those receiving >7 days compared with those receiving ≤7 days. Those receiving >400 total MME (15% of patients) were at 1.17 times (95% CI, 1.10-1.25) the risk of long-term use compared with those receiving ≤400 MME.

Conclusions: Between 2005 and 2015, the amounts of opioids prescribed for postoperative pain increased dramatically, and receipt of larger volume of opioids was associated with increased risk of long-term opioid therapy.

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Conflict of interest statement

Disclosures and conflicts of interest: All authors have no conflicts of interest to report. Until June 30, 2018, ND was a part-time employee of the RADARS System which had no knowledge of or involvement in this manuscript. RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado (USA). The RADARS System is supported by subscriptions from pharmaceutical manufacturers, governmental and nongovernmental agencies for data, research, and reporting services. Subscribers do not participate in data collection nor do they have access to raw data; Denver Health retains exclusive ownership of all data, databases, and systems. Employees are prohibited from personal financial relationships with any biopharmaceutical company. MJF receives salary support from the Center for Pharmacoepidemiology in the Department of Epidemiology, UNC (current members: GlaxoSmithKline, UCB BioSciences, Merck, Takeda). MJF is a member of the Scientific Steering Committee (SSC) for a postapproval safety study of an unrelated drug class funded by GSK. All compensation for services provided on the SSC is invoiced by and paid to UNC Chapel Hill.

Figures

FIGURE 1.
FIGURE 1.
Study schematic illustrating cohort enrollment criteria and follow-up.
FIGURE 2.
FIGURE 2.
Percent of patients receiving an initial perioperative prescription exceeding 7 days supply, stratified by sex and the 8 most common surgical sites.
FIGURE 3.
FIGURE 3.
Percent of patients receiving opioid prescriptions above various cut points and risk ratios of long-term use comparing those receiving opioid prescriptions above versus below various thresholds.
See this image and copyright information in PMC

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