Opioid use increases after bariatric surgery

Chronic use of opioids among obese patients prior to bariatric surgery continues after the surgery, according to recent Kaiser Permanente research.

“Despite a lack of evidence supporting long-term effectiveness of opioids for chronic non-cancer pain, long-term opioid use has increased recently,” says Marsha A. Raebel, PharmD, senior investigator at the Kaiser Permanente Colorado Institute for Health Research, Denver.

Dr. Raebel and colleagues examined the electronic medical records and other clinical and administrative databases of 11,719 obese patients who underwent bariatric surgery between 2005 and 2009.

In the year prior to their surgical procedures, the researchers found that 56% of the patients in the study reported no opioid use for pain management, 36% used some opioids and 8% used opioids on a chronic basis. The study was presented in the October Journal of the American Medical Association.

Seventy-seven percent of the obese patients who exhibited chronic opioid use prior to surgery continued to use these medications chronically one year after their procedure. Chronic opioid use among these patients also increased by 13% the first year after surgery and by 18% across three years after surgery.

Prescription opioid consumption and mortality are correlated and opioid abuse, accidental overdose, and death have increased, with overdose deaths rising in 2010 for the 11th consecutive year in the United States, she adds.

“No published studies assess chronic opioid use in the bariatric surgery population, and information is needed on whether weight loss attained after bariatric surgery is associated with reductions in opioid use,” Dr Raebel says. “Therefore, we undertook this study.”

There are limited options for pain management available to bariatric surgery patients because non-steroidal, anti-inflammatory medications increase the risk of gastric perforation, particularly after bariatric surgery and acetaminophen is less effective, according to Dr. Raebel.

“Given the increasing chronic usage of opioids we found after bariatric surgery relative to before surgery, it’s clear that we need to develop better pain management programs for patients who use opioids long-term following bariatric surgery,” she says.

Chronic opioid use was defined as having 10 or more prescriptions over at least 90 days or at least a 120-day total supply of medication sometime in the year prior to surgery. Some opioid use was defined as one to 9 prescriptions over 90 days or less than a 120-day supply.