Post-surgery pain medications fuelling global opioid crisis

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Targets to eliminate pain after surgery have driven increases in the use of opioids and are a major cause of the opioid crisis in the US, Canada and other countries, according to a series of articles published in The Lancet, bringing together global evidence detailing the role of surgery in the opioid crisis. 

Series from the Lancet journals - Postoperative pain management and opioids

Each year, there are 320 million people having surgery, and chronic pain occurs in 10% of cases. A US study of more than 155,000 patients having one of four low risk surgeries (carpal tunnel repair, knee arthroscopy, keyhole surgery for gallbladder removal, or keyhole surgery for inguinal hernia repair) found that opioid prescriptions for each type of surgery increased between 2004 and 2012, and that the average daily dose of opioid prescribed for post-surgical pain also increased by 13% (30 mg of morphine equivalent [MME]) across all procedures on average, with increases ranging from 8% (17 MMEs) for patients undergoing inguinal hernia repair to 18% (45 MMEs) for patients undergoing knee arthroscopy. 

There are also marked international differences in opioid prescribing after surgery. Data comparing one US and one Dutch hospital found that 77% of patients undergoing hip fracture repair in the US hospital received opioids, whereas none did in the Dutch hospital, and 82% of US patients received opioids after ankle fracture repair compared with 6% of Dutch patients. Despite these differences, patients in each of these countries show similar levels of satisfaction with pain management. 

In addition, excessive amounts of opioids are prescribed to US patients after surgery. Studies between 2011 and 2017 found that 67%–92% of US surgery patients reported not using all of their opioid tablets, typically leaving 42%–71% of their prescribed pills unused.

The Lancet authors called for a comprehensive approach to reduce these risks, including specialist transitional pain clinics, opioid disposal options for patients (such as secure medication disposal boxes and drug take-back events) to help reduce home-stored opioids and the risk of diversion, and options for non-opioid and opioid-sparing pain relief. More research is also needed to help effectively manage opioid tolerance and opioid-induced hyperalgesia.