High Risk of Persistent Opioid Use Among Adolescents Post-Surgery

One in six youths receive an opioid prescription before surgery, and 3% continue to fill opioid prescriptions three to six months post-surgery, indicating potential opioid dependence, according to a multi-institutional study ().

Risks of Persistent Opioid Use in Adolescents

Researchers from Children’s Hospital of Philadelphia (CHOP), Massachusetts General Hospital, University of Pennsylvania Perelman School of Medicine, and Stanford Medicine emphasize the need for more guidance to help clinicians avoid unnecessary opioid prescriptions and to recognize patient-specific risk factors for prolonged opioid use. The findings were published in the journal JAMA Network Open.

How to Prevent Opioid Addiction After Surgery?
Post-surgery opioid addiction may be prevented with a collaborative effort between surgeons and primary care physician. This may also allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.

‘One in six youths receive opioids pre-surgery, with 3% developing persistent use. #opioidcrisis #medindia’

Approximately 1.4 million youths undergo surgery annually in the United States, raising concerns about their susceptibility to opioid-related harms. Despite significant strides in reducing opioid prescriptions, it is crucial for clinicians to consider adolescent patients who may be at risk of developing an addiction due to various genetic, neurobiological, and social vulnerabilities. Prior to this study, little was known about the risks of persistent opioid use among adolescents and the timing of initial and refill opioid prescriptions.

“While prior analyses have shown a decline in opioid prescriptions in general, following surgical opioid prescribing recommendations remains a critical issue, especially for adolescents who are more inclined to engage in risk-taking behavior,” said first study author Tori N. Sutherland, MD, MPH, an attending anesthesiologist in the Department of Anesthesiology and Critical Care Medicine at CHOP.

Overprescription and Preoperative Opioid Use Among Adolescents

“Our study found that these patients are still filling prescriptions that are either not recommended or are in excess of what they may need. They are also filling prescriptions up to two weeks before surgeries not associated with severe pre-operative pain, putting young patients at risk for developing persistent use throughout their lives as they transition into adulthood.”

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Using a national insurance database of privately insured patients, the researchers looked at patients between 11 and 20 who underwent 22 surgical procedures that were either common or associated with severe postoperative pain requiring opioids for initial pain management. The patients had not taken opioids prior to their surgeries.

Of more than 100,000 patients, 46,951 (46.9%) patients filled a prescription for opioids, and 7587 (16.2%) of those had a prescription filled up to two weeks prior to surgery for procedures unlikely to be associated with severe preoperative pain. In this group, 6,467 (13.8%) patients filled a second prescription for opioids, and 1216 (3.0%) patients filled prescriptions between 91 and 180 days after their surgical procedure.

Opioid-Induced Hyperalgesia (OIH): An Emerging Treatment Challenge
Opioid induced hyperalgesia is defined as increased nociceptive sensitization caused by exposure to opioids.

One of the most important findings was that severe pain following a surgical procedure was not associated with persistent opioid use. However, patients with pre-existing chronic pain, who often underwent procedures associated with mild or moderate pain that could be managed with non-opioid medications, had increased odds of developing persistent opioid use.

“We believe this study underscores the need for establishing a standard of care for patients who undergo these procedures,” said senior study author Scott Hadland, MD, MPH, Chief of Adolescent and Young Adult Medicine at Mass General for Children and Associate Professor of Pediatrics at Harvard Medical School. “Effective pain management is critical and sometimes require opioids, but clinicians also need to make sure they are doing everything possible not to further contribute to the opioid addiction crisis, particularly with young patients.”

Risk Factors for Pediatric Opioid Dependence After Surgery
Key risk factors for persistent opioid use after surgery in pediatric patients have been discovered.

Reference:

Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery - (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767637)

Source-Eurekalert