Over the last 30 years, opioid prescription in the world has increased tenfold. Accounting for 80% of the world's opioid use, the United States has the highest rate of prescription opioid consumption globally. With abuse, addiction, and overdoses endangering millions, researchers have closely investigated the opioid epidemic. Understanding trends in postoperative opioid prescriptions is essential to improving healthcare's role in this crisis.
Among patients undergoing outpatient surgical procedures, "about 80 to 90% of them receive opioid prescriptions." Similarly, "99% of hospitalized surgical patients take opioids during their hospital stay," often warranting at-home use post-discharge. A Chen et al. study of 1.3 million adults found "80.3% filled a postoperative opioid prescription" between 1994-2014. High-dose prescriptions occurred most frequently following orthopedic procedures, with prescribing increasing since long-acting opioids were introduced in the 1990s.
Despite widespread use, some studies document declining trends in particular contexts. Coquet and colleagues found prescribing rates in Veterans Health Administration and Medicaid programs decreased from 2010 to 2020. Similarly, postoperative opioid prescriptions following pediatric surgery have decreased at some facilities in recent years—an important development given risks of childhood addiction and respiratory depression.
Transitional pain services (TPS) have successfully helped chronic opioid users manage postoperative pain. A 2022 Salt Lake City VA Medical Center study found chronic opioid users in TPS programs, despite receiving few opioid pills, demonstrated no pain recovery differences compared to non-opioid users. Chronic users returned to baseline levels quickly, supporting low-dose regimens and corroborating TPS effectiveness for high-risk patients.
Geriatric populations demonstrate relatively low postoperative opioid usage. From 2014-2019 at Mount Sinai Hospital, geriatric patients were significantly less likely receiving opioids than non-geriatric patients. However, internal dosage divisions existed: patients aged 65-74 received significantly higher doses than those 85 and older. While unclear if national trends reflect this pattern, it underscores considering age when developing opioid-related policies.
With increasing regulatory attention, policymakers must account for dosage prescribed, prescription context, and patient age. "Only with a complete understanding of these trends can the responsible authorities make regulations" that address root causes rather than overlooking specific populations.