PH Patients at High Risk of Misusing Opioids After Surgery
People with pulmonary hypertension (PH) who start treatment with opioids to manage pain after undergoing surgery are at high risk of continuing to take these addictive medications for longer than required, new research suggests.
Indeed, hypertension was one of eight specifically identified “top risk factors” for “new persistent post-surgical opioid use,” according to researchers, who said intervention measures could be key for prevention.
“Our findings identify which patients would most benefit from effective preoperative consultation and should be followed especially carefully after surgery,” Gia Pittet, PhD, a researcher at the University of California, Los Angeles (UCLA), and the study’s lead author, said in a press release.
The findings were shared at the Anesthesiology 2021 annual meeting, in the presentation “Identification Of Risk Factors For New Persistent Opioid Use After Surgery.”
Opioids are a class of drugs derived from compounds found in the poppy plant that are used to relieve pain. These include approved prescription medications like hydrocodone, oxycodone, and morphine, as well as substances that are widely illegal, such as heroin.
Although opioids can be highly effective at easing pain, they also can be very addictive and carry a high risk of overdose, which can be deadly — last year, nearly 100,000 people in the U.S. died of overdoses on opioids and other drugs, according to the Centers for Disease Control and Prevention.
One of the more common prescriptions for opioid use in a clinical context is to help manage pain while recovering from surgery. However, there is a risk that people will use these medicines improperly — often without intending to or realizing that they are doing so.
Since more than 100 million surgeries are performed every year in the U.S., prescriptions for pain medications following procedures “create an unintended and alarming gateway to long-term opioid use,” according to Pittet.
Using prescription data available through UCLA, Pittet and her colleagues conducted an analysis of 13,970 adults who underwent invasive surgery and were prescribed opioids. Notably, all of the patients were “opioid-naïve,” meaning they had not been prescribed opioids 31 days to one year before surgery (of note, patients often are prescribed opioids in advance so ensure they are immediately available after the surgery).
The team specifically looked at patients who continued using opioids for more than three months after a surgical intervention. The researchers noted that very few patients require opioid treatment for that long, unless they have cancer or had chronic pain prior to surgery.
The results showed that more than one in five patients — 21.2% — filled prescriptions for opioids more than three months after surgery — highlighting that opioid misuse is a “significant issue,” the researchers wrote.
“Clearly the management of opioid administration during the postoperative [after-surgery] period needs to extend well beyond the hospital stay, with better transfer of care to the primary care physician,” Pittet said.
The team then looked for factors associated with a higher risk of persistent opioid use. One of the strongest pre-surgical factors found was having PH. Other strong predictors of long-term opioid use included smoking cigarettes, depression, and bipolar disorder.
Female sex, age between 35-79 years, and white, black, and/or Pacific Islander races were found to be the top risk genetic/personal factors contributing to a higher risk of persistent post-surgery opioid use.
Patients fitting into any of these categories could benefit from effective pre-surgery (preoperative) consultation — and should be followed “especially carefully” after their procedures — Pittet said.
According to Pittet, physician anesthesiologists should use the preoperative assessment to identify patients at high risk for long-term opioid use.
“Before they have surgery, patients who smoke should be encouraged to quit, those with pulmonary hypertension should see a doctor to help them get the condition under control and patients with bipolar disorder or depression may require a preoperative adjustment of their medication,” she said.
The researchers also stressed the importance of patient education to minimize the risk of opioid misuse.
Other analyses showed that certain types of surgeries — specifically procedures on the eye, feet, or heart — were tied with a high risk of long-term opioid use.
“Future research is needed to better understand the unexpected high incidence of persistent opioid use seen with certain surgical procedures,” the researchers wrote.
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