Predicting Prolonged Opioid Use After Surgery

Predicting Prolonged Opioid Use After Surgery

Opioid drug use in patients with chronic pain has been linked to psychological distress and substance abuse. Studies suggest that these factors are often more influential than the intensity of pain patients are experiencing. The determinants of the duration of opioid use after surgery have not been reported in previous research. Furthermore, few analyses have explored the factors that affect ongoing use of opioids after surgery.  In Anesthesiology & Analgesia, my colleagues and I had a study published that sought to determine preoperative factors that predict continued use of opioids long after surgery. Preoperative psychological distress and prior substance use was assessed in 109 patients who were undergoing various operations. After surgery, daily use of opioids was measured until patients reported ceasing use of these drugs and having no pain. Three Important Factors According to our results, three preoperative factors were independently related to long-term opioid use: 1. Legitimate prescribed opioid use. 2. Self-perceived risk of addiction. 3. Depressive symptoms. Patients who were using opioids for pain relief before their procedure had a 73% higher likelihood of using these drugs at follow-up. Individuals who rated themselves at increased risk of developing an addiction were more likely to be long-term opioid users. The risk increased 53% for each 1-point increase on a 4-point scale of perceived addiction risk. Patients with symptoms of depression had a 42% higher risk for each 10-point increase on the Beck Depression Inventory scale. The three factors identified in our study were significant regardless of the type of surgery patients underwent. These factors were also better predictors of long-term opioid drug use than the severity of...

Looking at Alcohol Use Disorders Among Surgeons

The prevalence of substance use disorders in the United States has been well documented in published research. Nearly 8% to 12% of Americans aged 12 and older meet criteria for alcohol abuse or dependence, with men being twice as likely to depend upon or abuse alcohol as women. The prevalence of substance use disorders among U.S. physicians has been estimated to range from 10% to 15%, but less is known about alcohol dependence and abuse in particular. “Although actual injury to patients from impaired physicians is incredibly rare, alcohol abuse and dependence are important factors to consider when thinking about patient safety in surgery,” says Michael R. Oreskovich, MD. “These disorders can play a major role in causing clinically significant impairment or distress in social, occupational, and other areas of functioning.” Alcohol Use Disorder: A Problem for Surgeons Nationwide Dr. Oreskovich and colleagues conducted a study, published in the February 2012 Archives of Surgery, in which American surgeons completed online surveys anonymously. “We wanted to gain a better picture of the actual prevalence of alcohol dependence and abuse,” he says. “We also wanted to explore personal and professional characteristics, surgeon distress, and recent self-reported events.” According to the results, about 15% of respondents overall appeared to suffer from alcohol abuse or dependence, a figure that exceeds what has typically been cited for the general public. “Surprisingly, male surgeons were less likely to have these disorders than female surgeons,” Dr. Oreskovich says. “About 14% of male surgeons reported having alcohol issues, compared with a 26% rate that was observed for female surgeons.” In addition, the study found that alcohol issues...