Long-Term Opioid Use Can Start After Surgery, New Study Shows
Before you consent to a surgical procedure, it’s standard practice for someone on your treatment team to talk to you about the things that could go wrong—blood clots or infections, for example. But there’s one risk you and your doctors may not have considered: getting hooked on opioid painkillers after surgery.
A study published Wednesday in JAMA Surgery suggests that many people start down the road of long-term opioid use when their doctors prescribe medications such as OxyContin, Percocet, or Vicodin to relieve post-surgical pain.
The biggest surprise? People undergoing even minor outpatient procedures—hemorrhoid or varicose vein removal, for example—were just as likely to get hooked on opioids as those undergoing major surgeries such as a hysterectomy.
Researchers from the University of Michigan Medical School examined the records of more than 36,000 adults younger than 65 who underwent surgery and who had not taken opioid pain medication the year prior to their procedure.
Three months after surgery, when nearly all patients should have recovered, the researchers discovered that about 6 percent were still taking opioids.
“Six percent may not sound like a lot, but when you consider that 50 million Americans undergo outpatient procedures each year, the implications are staggering,” says Chad Brummett, M.D., director of pain research at the University of Michigan Medical School and lead author on the study. “Up to 3 million people may become newly dependent on opioids each year simply because they started taking the drugs after a minor day surgery.”
“If we want to make a dent in the opioid epidemic, being more thoughtful about how we manage pain after surgery is a good place to start,” says Brummett.
When Days Turn into Months
A recent study published by the Centers for Disease Control and Prevention (CDC) found that taking opioids for more than a few days sharply increases your risk of getting hooked on the drugs.
Over time, opioids can affect your mind and body in ways that make it hard to stop taking them, says Brummett.
People who continue taking opioid painkillers after surgery for more than two weeks often become physically dependent on the drugs, meaning that they can suffer withdrawal symptoms—including worsened pain, nausea, anxiety, and sleeplessness—if they try to stop abruptly without tapering off the drugs.
And up to one in four people taking opioids longer than three months shows signs of becoming addicted, according to the CDC.
In those cases, people may crave the drug between doses, continue to take it even though it is more harmful than helpful, and want to cut back or stop but be unable to do so, says Brummett.
The JAMA Surgery study did not look at why some people stayed on opioids for months after their surgery or whether they had become addicted to the drugs.
But the results did show that some people were particularly vulnerable to becoming long-term opioid users, including those who smoke cigarettes or who had a history of alcohol or substance abuse, anxiety or mood disorders, or pain before their surgery.
“Other research has shown that those same groups are more prone to addiction,” says Brummett.
Be Smart About Painkillers After Surgery
Orly Avitzur, M.D., Consumer Reports’ medical director, says make a plan with your doctor before your surgery about how you will manage pain.
One reason that people get into trouble is that doctors frequently prescribe far more painkillers after surgery than people actually need, says Avitzur. In the JAMA surgery study, for example, doctors prescribed an average of 14 days’ worth of opioids for patients undergoing minor procedures.
“But some people having an outpatient procedure may not need opioids at all,” says Avitzur.
“And even when an opioid is warranted, most people can transition to safer over-the-counter pain medication within three days,” she says. “Few people need powerful prescription pain drugs for more than a few days to a week.”
The safest approach is for doctors to prescribe only a few days’ worth of opioids and then reassess your pain level and medication needs, says Avitzur.
If you do wind up with unused prescription pain medication, don’t hang on to it. Too often leftover opioids wind up being misused—either intentionally or not—and can even prove deadly. Instead, follow our easy steps for getting rid of unused medication.
Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
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