Inappropriate opioid prescription after surgery

Abstract

Worldwide, the use of prescription opioid analgesics more than doubled between 2001 and 2013, with several countries, including the USA, Canada, and Australia, experiencing epidemics of opioid misuse and abuse over this period. In this context, excessive prescribing of opioids for pain treatment after surgery has been recognised as an important concern for public health and a potential contributor to patterns of opioid misuse and related harm. In the second paper in this Series we review the evolution of prescription opioid use for pain treatment after surgery in the USA, Canada, and other countries. We summarise evidence on the extent of opioid overprescribing after surgery and its potential association with subsequent opioid misuse, diversion, and the development of opioid use disorder. We discuss evidence on patient, physician, and system-level predictors of excessive prescribing after surgery, and summarise recent work on clinical and policy efforts to reduce such prescribing while ensuring adequate pain control.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Figures

Figure:. Increasing prescribing of opioids after surgery in the USA

Changes in patterns of postoperative opioid prescribing between 2002 and 2012 for four common low-risk procedures among 155 297 US adults who had private insurance and did not use opioids 6 months before surgery. (A) The percentage of all patients filling any opioid prescription within the first 7 days after surgery by year and procedure type. (B) The average amount of opioid pain medication received in morphine equivalents among those filling a prescription by year and procedure type.