We recently published a study of postsurgical prescriptions for opioid
and their association with overdose and misuse, We're Gabriel Brat and
Denis Agniel, AMA!
Abstract
The United States is currently experiencing an opioid crisis. The CDC
website has some chilling facts: The majority of drug overdose deaths
(66%) involve an opioid. In 2016, the number of overdose deaths
involving opioids was 5 times higher than in 1999. From 2000 to 2016,
more than 600,000 people died from drug overdoses. On average, 115
Americans die every day from an opioid overdose. Despite all this,
opioids remain an effective treatment for post-operative pain. Surgeons
struggle with adequately treating their patients’ pain needs while being
mindful of the risks of opioids. Not enough is known about the risks of
treating patients with longer durations and stronger doses of opioids.
In our paper published in the BMJ, we quantified the association between
the amount of opioids patients received directly after surgery and the
rate of misusing opioids (including overdose, abuse, and dependence) in
more than 500,000 surgery patients enrolled in commercial medical
insurance who received opioids. We found that each additional refill a
patient received was associated with a more than 40% increase in the
rate of misuse and each additional week of opioids with a 20% increase.
The dose of opioids had a much smaller impact and only seemed to become
important among patients who used opioids for an extended period. Those
numbers are based on statistical models that take into many factors
about the patients, including their surgery type, age, sex, and certain
diagnoses that they might have received before surgery like tobacco use
disorder or depression. To give you a sense of some related unadjusted
data, 0.18% of patients with no refills experienced a misuse event
within one year after surgery. That number doubles to 0.37% among those
who filled just one additional opioid prescription after surgery. And it
jumps all the way to 1.1% among those with more than 5 refills. Our
main analysis included all misuse events (not just those that happened
within one year after surgery) and showed very similar results. AMA! We
are: Gabriel Brat, instructor in surgery and in biomedical informatics
at Harvard Medical School and a trauma surgeon at Beth Israel Deaconess
Medical Center Denis Agniel, associate statistician at the RAND
Corporation and part-time lecturer at Harvard Medical School
Postsurgical prescriptions for opioid naive patients and association
with overdose and misuse: retrospective cohort study BMJ 2018; 360 doi:
https://doi.org/10.1136/bmj.j5790 Edit: Thanks everyone for all the
questions. We are signing off now, but we will check in later to
participate in further discussion.