Over the last 30 years, opioid prescription in the world has increased tenfold [1]. Accounting for 80% of the world’s opioid use, the United States has the highest rate of prescription opioid consumption in the world [1]. With a seemingly endless stream of abuse, addiction, and overdoses endangering millions of people, it is no wonder that researchers have closely investigated the opioid epidemic. Understanding and analyzing trends in postoperative opioid prescriptions is needed to be able to improve the role of healthcare in this crisis.
To begin, consider some general trends in postoperative opioid prescriptions. Among patients who undergo an outpatient surgical procedure, about 80 to 90% of them receive opioid prescriptions [1]. Similarly, 99% of hospitalized surgical patients take opioids during their hospital stay which, in many cases, warrants at-home opioid use upon discharge [1]. A study by Chen et al. found that, out of 1.3 million adult subjects who filed commercial healthcare claims from 1994 to 2014, “80.3% filled a postoperative opioid prescription” [1]. High-dose prescriptions, which accounted for one in five prescriptions, were most likely following orthopedic procedures [1]. Overall, the researchers noted an increase in postoperative opioid prescriptions since the 1990s, when long-acting opioids were introduced in the US [1].
While some findings clearly show how widespread opioid use is in the US wstudies have shown downward trends in postoperative opioid prescriptions in particular contexts.
While these findings clearly show how widespread opioid use is in the United States within medicine, some studies have shown downward trends in postoperative opioid prescriptions in particular contexts. For instance, Coquet and colleagues found that prescribing rates in Veterans Health Administration (VHA) and Medicaid programs decreased from 2010 to 2020 [2]. Likewise, opioid prescription following pediatric surgery appears to have decreased over the last few years in some medical facilities [3, 4]. Given how opioid use by children can not only cultivate long-term addiction but also result in respiratory depression and other adverse outcomes, this is an important development [4].
Another welcome development is the success of transitional pain services (TPS) in helping chronic opioid users manage their opioid use after surgery [5]. This result emerged from a 2022 study focusing on the implementation of a TPS at the Salt Lake City VA Medical Center [5]. The TPS consisted of classes on pain-control therapies and the development of a personal pain plan, among other strategies [5]. Despite receiving few opioid pills, the patients in the experiment group, all of whom were chronic opioid users, demonstrated no differences in pain recovery compared to the non-opioid users in the control group [5]. Moreover, chronic users returned to their baseline levels quickly, indicating the effectiveness of low-dose postoperative opioid regimens [5]. Similar findings have been noted by other researchers [6], corroborating the merits of TPS for patients who already take opioids and may be at higher risk of addiction and other negative outcomes.
One last trend to consider is the relatively low usage of opioids postoperatively by geriatric populations. From 2014 to 2019 at Mount Sinai Hospital, geriatric patients were significantly less likely to be prescribed opioids than non-geriatric patients [7]. However, there was an internal division in dosage among geriatric patients: those aged 65 to 74 typically received significantly higher doses than those aged 85 and up [7]. While it is unclear whether this trend reflects geriatric prescription trends throughout the country, it demonstrates the importance of also considering age when crafting policies meant to address the opioid epidemic.
With increasing attention being turned to opioid regulations, it is crucial to take into account the various issues raised by these trends, including the dosage prescribed, the context of the prescription, and the patient’s age. Only with a complete understanding of these trends can the responsible authorities make regulations that, rather than overlook certain populations because of their generality, strike at the roots of this problem and help the millions of people affected by opioids.
References
[1] C. L. Chen et al., “Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014,” Journal of American Academy of Orthopedic Surgeons Global Research & Reviews, vol. 4, no. 1, January 2020. [Online]. Available: https://doi.org/10.5435%2FJAAOSGlobal-D-19-00171.
[2] J. Coquet et al., “Changes in postoperative opioid prescribing across three diverse healthcare systems, 2010–2020,” Frontiers in Digital Health, vol. 4, December 2022. [Online]. Available: https://doi.org/10.3389/fdgth.2022.995497/full.
[3] G. C. Donohoe et al., “Trends in Postoperative Opioid Prescribing in Outpatient Pediatric Surgery,” Pain Medicine, vol. 20, no. 9, pp. 1789-1795, September 2019. [Online]. Available: https://doi.org/10.1093/pm/pny284.
[4] T. N. Sutherland et al., “Trends in Routine Opioid Dispensing After Common Pediatric Surgeries in the United States: 2014–2019,” Pediatrics, vol. 149, no. 5, April 2022. [Online]. Available: https://doi.org/10.1542/peds.2021-054729.
[5] J. Bleicher et al., “Postoperative opioid prescribing, use and pain trends following general surgery procedures: a retrospective cohort study among veterans comparing non-opioid versus chronic opioid users,” Regional Anesthesia & Pain Medicine, vol. 47, no. 8, pp. 487-493, May 2022. [Online]. Available: https://rapm.bmj.com/content/47/8/487.
[6] J. Mikhaeil et al., “Review of the Transitional Pain Service as a method of postoperative opioid weaning and a service aimed at minimizing the risk of chronic post-surgical pain,” Anaesthesiology Intensive Therapy, vol. 52, no. 2, February 2020. [Online]. Available: https://doi.org/10.5114/ait.2020.96018.
[7] J. Dias, S. Zaveri, and C. Divino, “Postoperative opioid prescribing patterns in the geriatric patient population,” The American Journal of Surgery, vol. 224, no. 1B, pp. 418-422, July 2022. [Online]. Available: https://doi.org/10.1016/j.amjsurg.2021.12.029.
