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. 2019 Sep 4;2(9):e1910734.
doi: 10.1001/jamanetworkopen.2019.10734.

Opioid Prescribing After Surgery in the United States, Canada, and Sweden

Karim S Ladha  1   2   3 , Mark D Neuman  4   5   6 , Gabriella Broms  7   8 , Jennifer Bethell  9   10 , Brian T Bateman  11   12 , Duminda N Wijeysundera  1   2   3   9 , Max Bell  13   14 , Linn Hallqvist  13   14 , Tobias Svensson  15 , Craig W Newcomb  16 , Colleen M Brensinger  16 , Lakisha J Gaskins  5   6 , Hannah Wunsch  2   9   10   17   18
Affiliations

Opioid Prescribing After Surgery in the United States, Canada, and Sweden

Karim S Ladha et al. JAMA Netw Open. .

Abstract

Importance: Small studies and anecdotal evidence suggest marked differences in the use of opioids after surgery internationally; however, this has not been evaluated systematically across populations receiving similar procedures in different countries.

Objective: To determine whether there are differences in the frequency, amount, and type of opioids dispensed after surgery among the United States, Canada, and Sweden.

Design, setting, and participants: This cohort study included patients without previous opioid prescriptions aged 16 to 64 years who underwent 4 low-risk surgical procedures (ie, laparoscopic cholecystectomy, laparoscopic appendectomy, arthroscopic knee meniscectomy, and breast excision) between January 2013 and December 2015 in the United States, between July 2013 and March 2016 in Canada, and between January 2013 and December 2014 in Sweden. Data analysis was conducted in all 3 countries from July 2018 to October 2018.

Main outcomes and measures: The main outcome was postoperative opioid prescriptions filled within 7 days after discharge; the percentage of patients who filled a prescription, the total morphine milligram equivalent (MME) dose, and type of opioid dispensed were compared.

Results: The study sample consisted of 129 379 patients in the United States, 84 653 in Canada, and 9802 in Sweden. Overall, 52 427 patients (40.5%) in the United States were men, with a mean (SD) age of 45.1 (12.7) years; in Canada, 25 074 patients (29.6%) were men, with a mean (SD) age of 43.5 (13.0) years; and in Sweden, 3314 (33.8%) were men, with a mean (SD) age of 42.5 (13.0). The proportion of patients in Sweden who filled an opioid prescription within the first 7 days after discharge for any procedure was lower than patients treated in the United States and Canada (Sweden, 1086 [11.1%]; United States, 98 594 [76.2%]; Canada, 66 544 [78.6%]; P < .001). For patients who filled a prescription, the mean (SD) MME dispensed within 7 days of discharge was highest in United States (247 [145] MME vs 169 [93] MME in Canada and 197 [191] MME in Sweden). Codeine and tramadol were more commonly dispensed in Canada (codeine, 26 136 patients [39.3%]; tramadol, 12 285 patients [18.5%]) and Sweden (codeine, 170 patients [15.7%]; tramadol, 315 patients [29.0%]) than in the United States (codeine, 3210 patients [3.3%]; tramadol, 3425 patients [3.5%]).

Conclusions and relevance: The findings indicate that the United States and Canada have a 7-fold higher rate of opioid prescriptions filled in the immediate postoperative period compared with Sweden. Of the 3 countries examined, the mean dose of opioids for most surgical procedures was highest in the United States.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Ladha, Wijeysundera, and Wunsch reported receiving support from Merit Awards from the Department of Anesthesia at the University of Toronto. Dr Broms reported receiving support from the Stockholm County Council. Drs Bethell, Newcomb, and Brensinger reported receiving grants from the National Institute on Drug Abuse during the conduct of the study. Dr Bateman reported receiving grants from the National Institutes of Health, the US Food and Drug Administration, Eli Lilly and Company, GlaxoSmithKline, Pfizer, Baxalta, and Pacira BioSciences; receiving personal fees from Aetion and Alosa Health; and consulting on a postpartum hemorrhage quality improvement project sponsored by a grant from Merck for Mothers outside the submitted work. Dr Wijeysundera reported being supported by a New Investigator Award from the Canadian Institutes of Health Research as well as the Endowed Chair in Translational Anesthesiology Research at St. Michael’s Hospital and University of Toronto. Dr Wunsch reported receiving a grant from the Canadian Institute of Health Research outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Cohort Formation in Each Country
Figure 2.
Figure 2.. Percentage of Patients Filling an Opioid Prescription During First 7 Days After Surgery
Error bars represent 95% CIs.
Figure 3.
Figure 3.. Distribution of Types of Opioids in First Prescriptions Filled
Figure 4.
Figure 4.. Distribution of Morphine Milligram Equivalents (MMEs) Dispensed for First Prescriptions Filled
Error bars represent 95% CIs.
See this image and copyright information in PMC

Comment in

References

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