A recent study conducted across multiple institutions revealed that 1 in 6 young patients receive opioid prescriptions before surgery, with 3% of patients continuing to fill opioid prescriptions for three to six months post-surgery. This indicates a concerning trend of persistent opioid use and potential opioid dependence. The study highlights the need for improved guidelines to discourage unnecessary opioid prescriptions by healthcare providers and to identify individual patient-specific risk factors for sustained opioid use.
Every year, approximately 1.4 million young individuals undergo surgical procedures in the United States, raising concerns about their vulnerability to opioid-related risks. While efforts have been made to reduce opioid prescriptions, it’s crucial for clinicians to pay special attention to adolescent patients who may be at higher risk of developing opioid addictions due to various factors like genetics, neurobiology, and social influences. However, prior to this study, little was known about the likelihood of persistent opioid use among teenagers and the timing of initial and subsequent opioid prescriptions.
Lead study author Dr. Tori N. Sutherland, an anesthesiologist at Children’s Hospital of Philadelphia (CHOP), emphasized the importance of following proper opioid prescribing practices, especially for adolescents who may engage in risky behaviors. The study found that some patients continue to receive opioid prescriptions that are either excessive or unnecessary, even filling prescriptions before surgeries not typically associated with severe pre-operative pain, potentially increasing the risk of long-term opioid use as they transition into adulthood.
Using a national insurance database of privately insured patients aged between 11 and 20 who underwent common surgical procedures or those requiring opioids for postoperative pain management, researchers examined over 100,000 patients. Among them, 46.9% filled opioid prescriptions, with 16.2% receiving prescriptions prior to surgery for procedures where severe preoperative pain was unlikely. Of this group, 13.8% obtained a second opioid prescription, and 3.0% continued to fill prescriptions between 91 and 180 days post-surgery.
A significant finding was that severe postoperative pain did not correlate with persistent opioid use. Instead, patients with pre-existing chronic pain undergoing procedures associated with mild or moderate pain, manageable with non-opioid medications, were more likely to develop persistent opioid use.
Senior author Dr. Scott Hadland, Chief of Adolescent and Young Adult Medicine at Mass General for Children, stressed the importance of balancing effective pain management with the risks of contributing to the opioid crisis, especially in young patients.
The study received support from the Foundation for Anesthesia Education and Research (FAER) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases grant K24AR080786.
