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Post-Surgical Opioid Addictions: Is the Culprit Dosage Strength or Duration of Use?


Scientists and physicians are currently trying to determine the precise reason opioids have become such a problem in the United States. A glance at the latest statistics from the Center for Disease Control (CDC) will help you understand why clinical professionals are wondering where everything went wrong:
  • In the past 16 years, over 183,000 Americans have overdosed and died from opioids.
  • Heroin overdoses tripled between 2010 and 2015.
  • Adults ages 55-64 had the biggest increase in overdose deaths.
This article explores the results of a recent study that indicates the dosage strength of post-surgical opioids is less a predictor of potential misuse and abuse than the duration of use. What lessons can physicians learn from this study?

New Study on Addiction Medicine

A new study called “Postsurgical Prescriptions for Opioid Naïve Patients and Association with Overdose and Misuse: Retrospective Cohort Study,” published in the BMJ sought to correlate physician prescribing patterns with post-surgical opioid abuse. Researchers acknowledged that there has generally been a lack of clinical guidelines related to postsurgical prescribing for opioids. Research shows that typically 80 percent of long-term prescriptions remain unused. Little is know about the ultimate effects of larger and longer prescriptions of opioids after surgery. This makes it difficult for physicians to safely prescribe these very addictive and dangerous drugs while still helping postoperative patients with pain management. In the study, a group of researchers at the Harvard Medical School analyzed data from more than one million insured patients between the years 2008 and 2016. Fifty-six percent of these patients were prescribed post-op opioid medications. Two and a half years later, 5,906 of these patients were addicted to opioids (.6 percent of the study population). The researchers found a correlation between the number of weeks the medications were prescribed and a higher incidence of opioid addiction. The more often the prescriptions were refilled, the higher the incidence of addiction. Specifically, for every refill, the patient had a 44 percent higher chance of becoming addicted to opioids. The researchers concluded: Each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naïve patients. The data from this study suggest that duration of the prescription rather than the dosage is more strongly associated with ultimate misuse in the early post-surgical period. It has been assumed that overprescribing has been a contributing factor in the opioid epidemic, but it is not known exactly how. The researchers suggest that new postsurgical clinical guidelines should recommend that opioids be prescribed at higher doses for shorter lengths of time.

Addiction Treatment Starts with the Physician

While this study is the first of its kind and more research needs to be done, it seems clear that the physician is the first line of defense against opioid addiction. A cautious approach toward opioid prescribing is now recommended by much of the research. If you are a physician dealing with patients who have become addicted to opioid pain medication, contact us to find out more about referring patients to our facilities.
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