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Study: Long-Term Opioid Use Rarely Starts With Surgery

Some have blamed surgeons for the opioid crisis, but a study found chronic opioid users rarely got their first prescriptions after surgery.

Published: August 23, 2017

KEEP 'EM COMING Patients who continually refilled opioid prescriptions for 6 months or longer usually had either back pain or nonspecific diagnoses.

New research refutes the popular notion that surgeons are unwittingly enabling opioid addiction and abuse by overprescribing prescription painkillers for post-operative pain relief.

No, researchers say, patients most likely to use opioids for 6 months or more didn't get their first prescription from their surgeon, but for some sort of back pain or some other nebulous complaint of pain, according to a research letter published last week in the journal JAMA Surgery.

In fact, researchers found that patients leaving the hospital after surgery are rarely the ones whose chronic opioid use started with a surgeon's prescription.

The researchers based their conclusions on a retrospective analysis of more than 117,000 previously opioid-naïve patients who were prescribed opioids and who continued to refill their prescriptions more or less continuously for at least the following 6 months.

Of those, fewer than 1% got a first prescription after an inpatient encounter, and only 0.4% began taking opioids after undergoing an inpatient procedure.

For first-time users, by far the most common diagnosis (30.6%) was "other ill-defined conditions," a diagnostic code that encompasses an extremely wide range of maladies. Among patients treated in military facilities, lumbago (lower back pain) was the most common first-step diagnosis (6.5%).

"As we search for causes of the opioid epidemic, we note that hospital events and associated procedures do not appear to be the main drivers," the authors conclude. Instead, they say, most diagnoses leading to first-time opioid prescriptions "were either nonspecific or associated with spinal or other conditions for which opioid administration is not considered standard of care."

Jim Burger

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