If You’re Prescribed Opioids after Injury or Surgery, Will You Become Dependent?

If You’re Prescribed Opioids after Injury or Surgery, Will You Become Dependent?

by Staff

We’ve all seen the massive media attention on the opioid epidemic and as the dust settles and changes are made to how opioids are viewed, we are left with a few takeaways.  One of them is that if someone is injured or has had surgery, prescribing opioids is a bad thing because many will become dependent.

A new study presented at the American College of Surgeons refutes this notion, reporting that up to one year after discharge from the hospital, only about 1 percent of trauma patients were reportedly still taking prescription opiates, or opioids, such as hydrocodone, oxycodone, morphine, and fentanyl.

“Our findings in patients who sustain traumatic injury contradict the popular narrative about the role that appropriate use of opioids may play in the rate of opioid abuse in this country,” said senior investigator Andrew Schoenfeld, MD, an orthopaedic surgeon at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, Boston.

This new study is one of the largest investigations of prescription opiate use among patients who sustained trauma and may have the longest continued follow-up one year after hospital discharge.

Their research was conducted using the 2007 to 2013 database of TRICARE, the Department of Defense health care system that insures active-duty military, reserve members, retired veterans, and their dependents. Because most TRICARE plan members are currently civilians, Dr. Schoenfeld said the study findings are generalizable to the U.S. population.

Included in the study were patients aged 18 to 64 years whose injuries were severe, as indicated by an Injury Severity Score of 9 or higher.  Patients with major trauma could be expected to receive opiate prescriptions after their hospitalization.  In all, 15,369 patients were included and none of the patients had filled an opiate prescription within six months before their injuries.

Although more than half of the patients in the study, or 8,282, filled at least one opiate prescription soon after discharge, only 8.9 percent (1,371 patients) continued to fill opiate prescriptions three months later, the investigators reported.  Continued prescription opiate use reportedly dropped to 3.9 percent (597 patients) at six months and 1.1 percent (175 patients) at one year.

“We were really surprised by how low the numbers were for long-term opiate use,” Dr. Schoenfeld said.  “It appears that traumatic injury is not a main driver for continued opioid use in patients who were not taking opioids prior to their injuries.”

To identify predictors of continuing use of prescription opiates after hospital discharge, the researchers evaluated patients’ demographic and medical factors and found increased risk of continued opioid use among the following:

  • Patients ages 45 to 64 compared to those 18 to 24.
  • Lower socioeconomic status
  • Those who are married (although these finding probably cannot be generalized to the U.S. population, according to Dr. Schoenfeld, because military families tend to marry earlier than civilians do.)

“We wish to emphasize that health care providers should not withhold opiate painkillers because a patient has any of the identified risk factors from this study,” Dr. Schoenfeld said.  “At-risk patients can benefit from closer follow-up with their health care providers and, for those at high risk, a referral to the hospital’s pain management service.”

The study results were presented at the 2016 Clinical Congress of the American College of Surgeons.

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Authored by: Staff

There are 13 comments for this article
  1. J at 5:14 am

    This is not true for the most part with people that have real chronic pain! I have chronic pain and I only take medication for the pain. When there’s no pain there is no medication.

  2. Carol at 8:20 pm

    OK let me start by saying I was born with MSK. It is a very painful disease and I pass stones almost daily. I am 57 years old and my first stone was at age 18. I have been on excessive amounts of narcotics as needed both in the hospital and at home. I had a great Nephrologist and a very fulfilling life and absolutely NO never became addicted. Now as I progressed in age, and after literally hundreds of procedures and surgeries yes I was on pain medication daily. I started pain management when I was 52 years old. 5 years of handling my pain at home was a blessing. However now I am back to endless er visits and hospitalizations that could have been avoided by dealing with my situation at home. I never needed an increase in my medication in those 5 years. I have been with the same pharmacy for 35 years. I am a caretaker for 3 people… this needless pain and suffering must end. Doesn’t the government realize the huge cost of this ignorant war on narcotics? Pain prescriptions are plummeting yet heroin is surging! We allowed the Surgeon General to impose such strict scrunity and sanctions upon not only ourselves but also our physicians whom are petrified to write an essential medication! This is all a bunch of rhetoric! Possibly I am wrong but in my experience no you will not become addicted to short term or on and off prescribing of medically necessary pain medication.

  3. Alix Stuckel at 8:12 pm

    I had a ‘severe’ injury in 2005. I was placed on massive doses of opiods. It took that much to get my pain under control from having crushed part of my spine. A year later I was off opiods, but not out of pain. Five years later, I was back on opiods, but only enough to keep me from screaming. I have never been put on enough pain management to be functional. Because of a lack of pain management, I am no longer a viable member of society. I am not able to work, or interact with people, or have any quality of life. My spine is continuing to worsen, but I have been told that the VA will soon end all opiods for chronic pain patients. I have only left the house once in the last two weeks, and I guess that will soon be taken away with my pain management. I have never abused opiods, just taken them for what they are for, pain.

  4. cliff macway at 3:14 pm

    Just wait till the idiots at the CDC or DEA need use opiates to help themselves or a family member and can’t get any. What will they do?? Well I think the doctors will just say, ‘ for the metal substance that we can’t remove from your spine, we can offer you some asprin for the incredible pain you will be suffering the rest of your life’.

  5. Doug at 2:15 pm

    It’s Communist Russia PRAVDA, American Style.
    The question I have, is the federal government censoring the press, or is the national news media’s onesided coverage based on the advertising dollars from addiction recovery centers? I’m willing to bet that the answer is the second half of my question.
    So with that in mind, wouldn’t profiting off the pain of others be considered to be promoting & condoning physical abuse?
    Then wouldn’t the deaths caused by this physical and emotional abuse, whether they are accidental or self inflicted be considered a text book definition of Genocide because it targets and entire group of people who are physically different?
    The World Health Organization (WHO) has already spoken out against the CDC & DEA for their activities against people in pain by stating that the refusal of efficient pain relief to anyone who needs it is inhumane.
    As far as the media’s 1st Ammendment right to freedom of the press. Basically the press has the exact same rights as the citizens do when it comes to freedom of speech. As long as the speech does not cause violence or harm it fits in to this category. As long as said speech is not racist or bigotry in any way it can be published. The national news media is and has been in violation of the 1st Ammendment by promoting their bias views towards users of opioid medications for the treatment of chronic pain and that’s why we need to target them.

    https://www.law.cornell.edu/wex/first_amendment

  6. scott michaels at 12:42 pm

    hey for me they wanted to do 3 surgeries. they said the pain might get better. i chose the medication, now ill probably have to do 3 surgeries and be in more pain then ever.
    mayve ill get a tylenol3 lol.
    They ha e no idea how many heroin users will be created by doing this.

  7. Doug at 11:04 am

    Last night I watched “LAST WEEK TONIGHT” with John Oliver and he had a segment on about the so called opioid epidemic. He actually quoted the scientific studies that indicate that only 1% of prescription opiates users become addicted as “Bull Sh**”. This is our conundrum, any and all media forums are denying real science and siding with the CDC guidelines.
    But one thing good about his report was that he stated that health insurance companies across the country refuse to pay for alternative medicine and treatment that could reduce the need for opiate medications in some cases.
    He also stated that there is and will always be a need for opiate pain medications.
    This is why my feelings are that we, the chronic pain community need to go after the national news media and make them tell the whole truth from both sides of this story. They need to define the difference between addiction, physically dependent and psychological dependency. We also need to demand that they show the good that opiates do for the masses of us who use them as directed and under the supervision of medical professionals who care.
    This conversation in the media has been one sided way too long. As long as the public only hears the only side they are reporting, the beliefs that opiates are evil will flow freely across the country.

  8. David at 10:48 am

    This pain has got to go away. I was hurt in 1999 I think the doctor should have the say. I know she is getting talked to. Whats the government going to do next. I had L5 S1 done in 2002 cage and screws now L4 L5 S1 disk bulge bone spurs and intervertabral disc displacement and intervertabral disk degeneration and thats not all cronic bowel obstructions and inttitception they cant figure why this is happening ridicules sorry for the spelling thanks for listening.

  9. scott michaels at 7:59 am

    because good patients take as directed, good doctors prescribe to the needs of the individual payient and then wean them off.
    its the lying drug ADDICTS that messed it up for us. Chronic patients do become dependent, however we dont finish the bottle in 4 days, they last 30 days. Thats until the cdc and dea messed it up. now that i am being forced to low dose my pain is getting very bad again. So i guess i need to take my care into my own hands. Send wife to her doctor and a few friends as well. Do they really think were stupid. Ill turn ti hard drugs if it means my pain goes away. thanks cdc.Your lies and false statistics have caused a rash of suicides and heroin overdoses. Every one of the deaths is on you!!!!!
    I refuse to be forced to live in severe pain when there is a remedy that has worked for ne for several years.

  10. Mark Ibsen at 7:58 am

    So
    The answer is “NO”
    With 99% confidence.
    CDC:
    Swing that pendulum back!

  11. MichaelL at 7:34 am

    This is just a repeat of the studies that have shown the same results for decades. They could be as high as five percent (studied by addictionologists) to 8/100,000 or 0/10,000 (the last one a burn patient study). The problem has always been the exaggeration of the problem made by the drug warriors and anti drug zealots. It is the only specialty where a 5% complication rate is a problem! Having been a pain management specialist, and now a disabled spinal cord injury patient, my experience is unusual. I have suffered the discrimination given to people that want only to have an acceptable quality of life. I previously sacrificed my medical career for the patients that needed compassionate care. It is sad that studies like this need to continue to be done when the information has been there for a couple of decades! The problem with opiate abuse is not caused by the acute/chronic pain patients! Give them a break, and a benefit of the doubt, people!

  12. Carl Dobs at 6:08 am

    Along those lines here is an abstract comparing withdrawal symptoms for people taking Tapentadol ER and Oxycodone ER (Nucynta and Oxycontin, respectively) for up to a year and then having the medication stopped abruptly. It is noted that over 70% of people in each group DID NOT HAVE ANY WITHDRAWAL SYMPTOMS, meaning there was no physical dependence in the majority of patients. No cases of addiction were reported.

    The media and the DEA perpetuate the myths that all pain medication is “highly addictive”. That may be true for addiction prone individuals, but it is not true for ALL people.

    The makers of Nucynta also have a more formal paper showing the same thing. It may be unpublished and I do not have access to it since I Retired.

    http://www.pmrjournal.org/article/S1934-1482(09)00848-X/abstract

  13. connie at 3:37 am

    Perhaps the increased risk groups are because they are the groups with the most people in them?