A new Penn Medicine study published in JAMA Cardiology found “10% of heart surgery patients who were prescribed opioid medications were still taking them more than 90 days after their procedures” and researchers “found a direct association between the initial dosing of opioids or oral morphine equivalents and the likelihood of persistent use 90 to 180 days after the surgery. The highest risk of prolonged use was found among patients who were prescribed more than 300mg OMEs (about 40 tablets of 5mg oxycodone).”
Health experts continue to warn that the overprescribing of opioids for short-term pain management can lead to opioid use disorder (OUD). “Drug overdose deaths continue to be a public health emergency,” according to the U.S. Centers for Disease Control and Prevention (CDC).
“Our findings support a much-needed shift toward decreasing opioid dosages at discharge and using alternative approaches to reduce the risk for persistent opioid use,” said Dr. Chase Brown, a cardiovascular surgery resident and the study’s lead author.
The research team examined the data of more than 25,000 patients who underwent coronary bypass grafting or heart surgery or replacement in the twelve-year span between 2004 and 2016” and found “60% of CABG patients and 53% of valve surgery patients filled an opioid prescription within 14 days of the surgery.” They also found that “9.6% of cardiac surgery patients continued to fill prescriptions between three to six months after their procedures. Nearly 9% of CABG patients continued to fill an opioid prescription six to nine months after surgery.”
Women were at higher risk than men to develop OUD, as were younger patients and those with preexisting medical conditions. About “8% of low-risk patients also considered continued to use opioids longer than three months after surgery,” the study cites.
“Cardiothoracic surgeons, cardiologists and primary care physicians should work together to enact evidence-based protocols to identify high-risk patients and minimize prescriptions via a multi-faceted pain management approach,” added cardiovascular surgeon Dr. Nimesh Desai, the study’s senior author. “Centers must adopt protocols to increase patient education and limit opioid prescriptions at discharge.”
The report concluded, “Opioids are used extensively after cardiothoracic surgery and nearly 1 of 10 patients will continue to use opioids over 90 days after surgery. Furthermore, higher OMEs prescribed at discharge were significantly associated with developing persistent use. Centers must adopt protocols to increase patient education and limit opioid prescriptions after discharge.”
The CDC recommends, “Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective pain treatment while reducing the number of people who potentially misuse or overdose from these drugs. Reducing exposure to prescription opioids, for situations where the risks of opioids outweigh the benefits, is a crucial part of prevention.”
To reduce the risk of opioid addiction and overdose, the CDC recommends several guidelines, including, “Academic detailing to educate providers about opioid prescribing guidelines and facilitating conversations with patients about the risks and benefits of pain treatment options” and improving “awareness and share resources about the risks of prescription opioids, and the cost of overdose on patients and families.”
Sources:
It’s time to lower opioid prescription doses in heart surgery patients, Penn researchers say
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