THE CHANCES OF ADDICTION WITH ANALGESIA

A perennial discussion about the appropriate management of pain relief in patients occurs on most wards every day.

Mrs Jones has buzzed again.

When you go in, she requests additional pain relief.

She feels that the amount prescribed is not enough.

This leads to the inevitable discussion about whether more analgesia will lead to addiction in this patient.

A study of over one million patients has quantified the chances of addiction.

They looked at the records of patients that were labelled “opioid naive”.

Opioid naive meant the patient had not used opioids for seven days or less during the sixty days before surgery.

56% of these patients filled a prescription for an opioid after surgery.

Mostly within three days of discharge.

5906 patients were subsequently identified as having met the criteria for “opioid misuse”over a three year period.

Opioid misuse in these patients was determined by diagnostic codes for opioid dependence, abuse  and/or overdose.

1857 patients were identified within the first post operative year.

So what were the chances of addiction?

0.58% of the patients over a three year period were identified as having opioid misuse.

0.18% in the first post operative year had opioid misuse identified in this study.

The three most common surgeries that had the highest rates of misuse were for musculoskeletal, digestive and integumentary systems.

These types of surgeries made up over 80% of the cases where misuse was identified.

The higher rates of misuse occur with younger men.

The number of post-discharge prescriptions was the best predictor of eventual opioid misuse.

The duration of use was associated with the likelihood of misuse.

For every week of opioid use, there was a twenty percent increase in misuse.

A single prescription refill increases the potential for misuse by more than 40%.

So to get that perennial discussion about whether Mrs Jones should have the pain relief she requested because she may become addicted, nurses now have an answer.

It is not the immediate pain relief that is the problem.

It is the pain relief after discharge that leads to addiction.

To learn more about opioid misuse, 

Brat, Gabriel A., et al. “Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study.” BMJ 360 (2018): j5790.

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