Risk Factors and Prevention Strategies for Postoperative Opioid Abuse

Shuai Zhao, Fan Chen, Anqi Feng, Wei Han, Yuan Zhang, Shuai Zhao, Fan Chen, Anqi Feng, Wei Han, Yuan Zhang

Abstract

Worldwide, 80% of patients who undergo surgery receive opioid analgesics as the fundamental agent for pain relief. However, the irrational use of opioids leads to excessive drug dependence and drug abuse, resulting in an increased mortality rate and huge economic loss. The crisis of opioid overuse remains a great challenge. In this review, we summarize several key factors in opioid abuse, including race, region, income, genetic factors, age and gender, smoking and alcohol abuse, history of chronic pain and analgesic drug abuse, surgery, neuropsychiatric illness, depression and antidepressant use, human factors, national policies, hospital regulations, and health insurance under treatment of pain. Furthermore, we present several prevention strategies, such as perioperative measures, opioid substitutes, treatment of the primary illness, emotional regulation, use of opioid antagonists, efforts of the state, hospitals, doctors and pharmacy benefit managers, gene therapy, and vaccines. Greater understanding and better assessment are required of the risks associated with opioid abuse to ensure the safety and analgesic effects of pain treatment after surgery.

Figures

Figure 1
Figure 1
Postoperative opioid overdoses by year. The proportion of patients with postoperative opioid overdoses increased from 0.6/1000 in 2002 to 1.1/1000 in 2012. This figure was adapted from the study by Cauley et al. [24].
Figure 2
Figure 2
Postoperative opioid overdoses by surgery type. The proportion of patients with postoperative opioid overdoses following different surgical procedures. The highest risk occurred following pneumonectomy (1.8/1000), followed by spinal fusion (1.2/1000). This figure was adapted from the study by Cauley et al. [24].
Figure 3
Figure 3
Long-term opioid use after major elective surgery. The proportion of patients with long-term opioid use at postoperative days 180, 270, and 365 following different surgical procedures. The highest risk occurred following thoracic surgery (1.7% at day 365). This figure was adapted from the study by Soneji et al. [77].
Figure 4
Figure 4
Long-term opioid use after open surgery vs. MI surgery. The proportion of patients with long-term opioid use at postoperative days 180, 270, and 365 after open surgery vs. MI surgery. The highest risk occurred following thoracic surgery (at day 365, 1.7% in open surgery and 1.3% in MI surgery). MI = minimally invasive. This figure was adapted from the study by Soneji et al. [77].

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Source: PubMed

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