At a time when unnecessary opioid drug prescribing is discouraged, physicians appear to be reducing post-surgery doses for seniors and more frequently prescribing non-opioid painkillers as well, according to a new study from Canada.
Doses trend lower
The opioid epidemic has greatly affected seniors, a growing number of whom have misused or become addicted to prescription drugs over the past two decades. In the study, investigators identified adults in the province of Ontario aged 66 years and older who had undergone one of 14 surgical procedures between 2013 and 2020. They followed yearly trends of new prescriptions for non-opioid and opioid analgesics filled within seven days of discharge.
The rates of opioid prescribing remained the same during the study period, but the dosages have trended lower, they found. At the same time, the percentage of patients filling separate non-opioid painkiller prescriptions such as acetaminophen or nonsteroidal anti-inflammatory drugs grew from 9% to 28%, they reported. Many of those patients also filled an opioid prescription as well.
Notably, patients who filled separate prescriptions for an opioid and a non-opioid analgesic were prescribed a lower opioid dose than those prescribed an opioid alone or a combination opioid/non-opioid analgesic such as oxycodone/acetaminophen.
Room for improvement
“While it’s good news that the doses in opioid prescriptions are being reduced, the fact that the actual number of opioid prescriptions filled has remained the same shows there is still an opportunity for improvement,” said lead author Naheed Jivraj, MBBS, MS, FRCPC, of the University of Toronto, Ontario.
“That’s particularly true for procedures associated with low postoperative pain that can be effectively controlled with non-opioid medications such as acetaminophen and non-steroidal anti-inflammatory drugs,” he said.
Undertreating pain after surgery has been linked to reduced quality of life, surgical complications, prolonged rehabilitation and the development of chronic pain, according to the Centers for Disease Control and Prevention. “Thus, in certain situations, the benefits of a limited course of opioids may outweigh the risks if pain management is inadequate with non-opioid therapies,” it counsels prescribers.
U.S. and Canada
Canada and the United States have experienced similar epidemics of opioid misuse and addiction. The United States may be comparable to Canada in its post-surgical opioid prescribing as well, at least according to one study. Investigators comparing post-surgery prescribing rates across four different procedures in the mid-to-late 2010s found that more than 70% of surgical patients in the United States and Canada filled opioid prescriptions, compared with only 11% in Sweden.
Related articles:
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CDC loosens controversial opioid prescribing guidelines for chronic pain
Nondrug interventions effective for LTC residents in pain, review finds
Most U.S. adults use non-opioids to treat chronic pain: study
