Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 May 1;35(5):e171-e176.
doi: 10.1097/BOT.0000000000001958.

Impact of Substance Use and Abuse on Opioid Demand in Lower Extremity Fracture Surgery

Daniel J Cunningham  1 , Micaela A LaRose  2 , Mark J Gage  1
Affiliations
Observational Study

Impact of Substance Use and Abuse on Opioid Demand in Lower Extremity Fracture Surgery

Daniel J Cunningham et al. J Orthop Trauma. .

Abstract

Objectives: To describe the perioperative opioid demand in a large population of patients undergoing lower extremity fracture fixation and to evaluate mental disorders such as substance abuse as risk factors for increased use.

Design: Retrospective, observational.

Setting: National insurance claims database.

Patients/participants: Twenty-three four hundred forty-one patients grouped by mental disorders such as depression, psychoses, alcohol abuse, tobacco abuse, drug abuse, and preoperative opioid filling undergoing operative treatment of lower extremity fractures (femoral shaft through ankle) between 2007 and 2017.

Intervention: Operative treatment of lower extremity fractures.

Main outcome measures: The primary outcome was filled opioid prescription volume converted to oxycodone 5-mg pill equivalents. Secondary outcomes included the number of filled prescriptions and the risk of obtaining 2 or more opioid prescriptions.

Results: Of 23,441 patients, 16,618 (70.9%), 8862 (37.8%), and 18,084 (77.1%) filled opioid prescriptions within 1-month preop to 90-day postop, 3-month postop to 1-year postop, and 1-month preop to 1-year postop, respectively. On average, patients filled 104, 69, and 173 oxycodone 5-mg pills at those time intervals. Alcohol, tobacco, drug abuse, and preoperative opioid filling were associated with increased perioperative opioid demand. Psychoses had a small effect on opioid demand, and depression had no significant impact.

Conclusions: This study reports the rate and volume of opioid prescription filling in patients undergoing lower extremity fracture surgery. Substance use and abuse were the main risk factors for increased perioperative opioid prescription filling. Providers should recognize these risk factors for increased use and be judicious when prescribing opioids. Enhanced patient education, increased nonopioid pain management strategies, and referral for substance use and abuse treatment may be helpful for these patients.

Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Frieden TR, Houry D. Reducing the risks of relief—the CDC opioid-prescribing guideline. N Engl J Med. 2016;374:1501–1504.
    1. Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015;23:267–271.
    1. Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372:241–248.
    1. Wide-ranging Online Data for Epidemiologic Research (WONDER): CDC NCfHS; 2017. Available at: https://healthdata.gov/dataset/wide-ranging-online-data-epidemiologic-re... .
    1. Scholl LSP, Kariisa M, Wilson N, et al. Drug and opioid-involved overdose deaths—United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2018;67:1419–1427.

Publication types

MeSH terms

Substances