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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!
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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.