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Opioid prescriptions after plastic surgery tied to long-term use

(Reuters Health) – Opioids account for more than 90 percent of the painkillers used after plastic surgery, according to a U.S. study that questions how often these addictive narcotics are necessary to ease discomfort after operations.

Researchers examined data on 466,677 people who had plastic and reconstructive procedures for the nose, eye, breast, abdomen or soft tissue from 2007 to 2015. Almost 55 percent of patients received painkiller prescriptions afterwards, and 92 percent of the prescriptions filled were for opioids.

Patients who filled an opioid prescription shortly before or after surgery were about three times as likely as those who didn’t to still be using opioids up to six months or even a year later, the study found.

“On the one hand, we do not want our patients to suffer in the postoperative period – we want to treat their pain,” said senior study author Dr. Sam Most, chief of the division of facial plastic and reconstructive surgery at Stanford University School of Medicine in California.

“At the same time, we do not want to cause further problems, such as prolonged use or even addiction,” Most said by email. “This is our quandary.”

None of the patients had filled prescriptions for opioids in the year before surgery.

Patients commonly need pain relief in the days or weeks after surgery. The researchers defined “persistent” opioid use as filling prescriptions for these narcotics between 90 and 180 days after surgery. More than 30,000 patients, or almost 7 percent, became persistent opioid users after surgery.

And more than 10,000 patients, or 2.3 percent, remained on these drugs even longer, still using opioids up to one year after surgery.

Many patients who filled opioid prescriptions after surgery had other ongoing health problems, researchers report in JAMA Facial Plastic Surgery. About 39 percent suffered from chronic pain, while 14 percent had existing substance abuse issues and 6 percent had anxiety.

Opioid prescriptions were most common after nose jobs, when they were prescribed 66 percent of the time.

And 61 percent of women who had breast reconstruction or enhancement surgery were prescribed opioids.

Prescription rates for opioids after nose and breast procedures have been rising in recent years, the study found, even as rates fell or held stable for other types of plastic surgery.

A limitation of the study is that researchers only had data on prescriptions filled, not how much medication patients actually took or whether they obtained additional opioids from friends, family or other sources. They also lacked data to determine whether or not the prescriptions were necessary or appropriate.

Even so, the findings add to evidence suggesting that prolonged opioid use after surgery might not be due to pain, the authors conclude. In some instances, alternative painkillers like acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibruprofen (Motrin) might be effective for managing pain after surgery, Most said.

“Opioids certainly have a role for severe post-operative pain, but our use of opioids in the U.S. has gone well beyond the need since the mid 1990’s,” said Dr. Chad Brummett, co-director of the Michigan Opioid Prescribing Engagement Network, and an anesthesiology professor at the University of Michigan Medical School in Ann Arbor.

“There are many surgeries for which opioids are not necessary but for which they are regularly prescribed,” Brummett, who wasn’t involved in the study, said by email. “We have undervalued simple, but effective medications, such as acetaminophen and non-steroidal anti-inflammatory medications (e.g. ibuprofen), which can be taken for a few days by the vast majority of patients without concern.”

SOURCE: JAMA Facial Plastic Surgery, online March 7, 2019.

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