Physicians are prescribing opioid pain relievers at unprecedented levels to patients undergoing low-risk surgeries, according to a study by University of Pennsylvania researchers. The study tracked prescription use from 2004 to 2012—years during which prescription opioid abuse increased.
The study was published in JAMA alongside new U.S. Centers for Disease Control and Prevention (CDC) guidelines for the prescription and use of opioid pain medications to manage chronic pain. According to the CDC, Americans face a prescription opioid abuse epidemic, with 2.1 million people experiencing a prescription opioid addiction in 2012. Drug overdose deaths hit an all-time high in 2014. More than 60% of those deaths were due to an opioid, and 78 people die each day from opioid overdoses.
Opioid Prescriptions Rise with Opioid Abuse
Researchers tracked 155,297 adults ages 18-64 using insurance claims. Each participant underwent at least one low-risk surgery in 2004, 2008, or 2012. Those surgeries included inguinal hernia repair, knee arthroscopy, carpal tunnel release, and laparoscopic cholecystectomy. The team excluded patients who had filled an opioid prescription in the past six months, eliminating the possibility of tracking people with a current opioid addiction.
Investigators then assessed the use of opioids by monitoring which patients filled opioid prescriptions after the procedure or within seven days of being discharged from the hospital. The number of patients who received opioid prescriptions for all four surgeries increased over time, suggesting doctors prescribed the drugs at continuously higher rates. For example, patients who underwent knee arthroscopy saw an increase in opioid prescription rates of more than 18% over eight years.
New CDC Opioid Prescription Guidelinesaddictive, they can also effectively relieve both acute and chronic pain. The CDC aims to balance the need for effective pain relief with an overall reduction in opioid abuse with its new guidelines, also published in JAMA. Those guidelines specifically target opioid prescriptions for people with chronic pain, and would not necessarily apply to surgical patients. However, the guidelines make it clear doctors should closely monitor their patients and always weigh the costs and benefits of opioid use. Some of the new guidelines include:
- Using non-opioid therapy whenever possible and relying on opioids only when the benefits of doing so outweigh the risks.
- Prescribing the lowest effective dosage, then reassessing risks and benefits when increasing the dosage.
- Offering evidence-based treatments to patients with opioid addictions.
- Using prescription drug monitoring program data, particularly when prescribing high-risk dosages or drug combinations.
- Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama. doi:10.1001/jama.2016.1464
- Penn researchers show rising opioid prescriptions following low-risk surgeries. (2016, March 18). Retrieved from http://www.uphs.upenn.edu/news/News_Releases/2016/03/neuman/
- Understanding the epidemic. (2016, March 14). Retrieved from http://www.cdc.gov/drugoverdose/epidemic/
- Volkow, N. D., MD. (2014, May 14). America’s addiction to opioids: Heroin and prescription drug abuse. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
- Wunsch, H., Wijeysundera, D. N., Passarella, M. A., & Neuman, M. D. (2016). Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. Jama. doi:10.1001/jama.2016.0130
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