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When Surgery Leads to a Prescription Painkiller Dependence

A new study finds that 6 percent of American adultswho have surgery are still on opioids months after their pain should be gone.
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(Photo: Kaje/Flickr)

(Photo: Kaje/Flickr)

How do people become addicted to pain pills? This question has taken on prime importance, as about two million Americans are thought to be dependent on prescription painkillers, and prescription-pill overdoses have quadrupled since 1999.

To combat addiction and death, doctors and lawmakers need to know how people end up using opioid painkillers, such as Vicodin and Percocet, when they shouldn’t be. One path to dependency is thought to be people taking pills their doctors prescribed and then staying on them far longer than they should. But how often this happens, and under what circumstances, is still under study.

Now, a new paper tells us how often people get in trouble with opioids after surgeries, when patients are sent home with a prescription to help them with their pain as they recover.In the database the study authors analyzed, 6 percent of adults who got surgery, who hadn’t filled a painkiller prescription in the year before their procedure, ended up filling opioid scripts three to six months after their surgeries. Many experts consider it risky for most people to be on opioids for months or years at a time, and want to see the practice become rarer in the United States. By three months, most people shouldn’t need prescription medicine for their post-surgery pain anymore, according to researchers, a team from the University of Michigan and Veterans Affairs in the state. It’s possible that some of those folks developed another condition requiring opioids after their surgeries, but it’s likely not all of them did: Among people in the same database who didn’t get surgery, less than 1 percent filled an opioid prescription during the same time period.

More than two million Americans every year may become persistent opioid users after surgeries.

The study included data about more than 36,000 adults who were covered by a nationwide insurance company and had surgeries in 2013 and 2014. Taking the 6 percent rate and multiplying it by all the procedures performed in the U.S., the Michigan team estimates that more than two million Americans every year may become persistent opioid users after surgeries.

The surgery patients who ended up filling opioid prescriptions months later were a little different from the majority of patients who didn’t: They were more likely to have chronic pain conditions, such as back pain or arthritis; to be regular tobacco users; to have substance-abuse disorders; and to have anxiety and mood disorders. Many of these characteristics echo research that shows that people with behavioral health conditions are more likely to get opioid prescriptions, even though they’re also uniquely vulnerable to overdoses.

Other studies have found similar rates of dependency after a new opioid prescription. For example, one recent paper found that 5 percent of people in Oregon who received an opioid prescription—and hadn’t been taking prescription painkillers before—became long-term users.

What does all this mean for doctors, policymakers, and other people interested in reducing the number of Americans who get hooked on opioids every year? It’s important to know that surgery is one path to a long-term opioid prescription, especially for the most vulnerable cases. The study on surgeries can’t tell why some people end up using opioids for months, or whether those folks will end up with a dependence or addiction that makes their lives worse. But if we assume that may happen to some patients — and we want fewer long-term opioid prescriptions for everyone — then experts have ideas for how to achieve those goals. Doctors could limit long-term prescriptions for everybody, for example, and make sure that patients have a realistic idea of how much pain they’ll have to cope with — even though they’re taking painkillers — after a surgery.