Elderly patients who are prescribed painkillers for chronic pain after surgery are at greater risk of addiction and other health problems from opioid use, according to a Canadian study. Over 10 percent of the patients were long-term opioid users a year after their surgery.
Researchers at the University of Toronto studied 10 years of hospital data from Ontario to identify patients who were 66-years of age and older, who had surgery for cataracts, varicose veins, gall bladder removal and other procedures that required only a short stay in the hospital. Opioids like codeine and oxycodone were often prescribed after surgery if the patient suffered from postoperative pain.
Nearly 28,000 patients received an opioid prescription within seven days of being discharged from the hospital. A year later, 2,857 of them (10.3%) were still taking opioid painkillers. The most commonly prescribed opioid after surgery was codeine, followed by oxycodone, although the use of oxycodone increased as time went on.
“Our findings suggest that the prescription of codeine after short-stay surgery may contribute to the use of other potent opioids, such as oxycodone, which have been shown to be associated with increased morbidity and mortality,” wrote lead author Asim Alam, MD, of the University of Toronto. “These points do not even consider that the continued use of opioids after one year raises the possibility that the exposure may result in addiction or physical dependence.”
Besides addiction, long term use of opioids has been linked to depression, sedation, constipation and respiratory problems. The abuse of opioids, OxyContin in particular, has been a major health problem in Canada. OxyContin was recently taken off the market and is being replaced by a new drug formula called OxyNeo that is harder to crush for snorting and injecting.
In a commentary on the study that was also published in the Archives of Internal Medicine, Mark D. Sullivan, MD, and Jane C. Ballantyne, MD, of the University of Washington School of Medicine in Seattle called for a “more honest appraisal” of the pros and cons of prescribing opioids to avoid the “disastrous effects” of their abuse.
“The collective clinical experience from 20 years of liberal opioid prescribing for chronic pain, together with the findings of recent population-based studies, suggests that long-term opioid therapy may benefit patients with severe suffering… but [it] is not often effective in achieving the goals originally envisaged, such as complete pain relief and functional restoration,” Sullivan and Ballantyne wrote.
In a second commentary, Beth D. Darnall, PhD, and Brett R. Stacey, MD, of Oregon Health & Science University in Portland noted that women are more likely to be prescribed opioids and more likely to take higher doses. They too called for greater caution in prescribing the painkillers. “Before initiating opioid treatment for chronic pain, in women or men, prescribers should fully assess the individual risks and benefits of the therapy and have a thorough discussion of the goals, risks and consequences of such therapy with each patient,” they wrote