New Research: Women Have Highest Rates Of Persistent Opioid Use Following Surgery

Americans were prescribed an exorbitant number of opioids in 2016 despite efforts to combat the nation’s growing opioid crisis, according to new research conducted by the QuintilesIMS Institute. The research report, The United States for Non-Dependence, shows individuals undergoing surgery are at particular risk. The overwhelming majority of patients (nine in 10) are exposed to opioids to manage postsurgical pain, and those given prescriptions received an average of 85 pills each. This new research represents the most current analysis of national trends in opioid prescribing.

Nearly 3 million individuals who had surgery in 2016 became persistent opioid users, continuing to take opioids three to six months after their procedure, according to the new research. Further, as a result of overprescribing, 3.3 billion pills were left unused by patients, making them available for potential diversion or misuse.

“We know that the majority of opioid addictions start with prescription medications, so it is critical to fight the opioid epidemic by minimizing exposure to these drugs, especially to vulnerable patient populations,” says Paul Sethi, MD, orthopaedic surgeon at Orthopaedic & Neurosurgery Specialists (ONS) and President of the ONS Foundation for Clinical Research and Education. “Combatting this problem requires a multi-factorial approach – clinicians need to be more vigilant with their prescribing, patients should feel empowered to speak candidly with their doctor and take ownership of their postsurgical pain management experience and effective non-opioid medications should be routinely incorporated into postsurgical analgesic regimens.”

This analysis also uncovered several key indicators that opioids pose a specific threat to women undergoing surgical procedures, with 40 percent more women than men becoming persistent users following a surgery. Middle-aged women, ages 40-59, are particularly at-risk, as they were prescribed more opioids than any other age group and receive twice as many prescriptions as their male counterparts. These women were also most likely to become newly persistent opioid users following surgery, with 13 percent taking the drugs long after their procedure. This scenario is especially dangerous for this age group, as women between 45 and 54 years old have the highest death rate from opioids among all females.

Although the overall risks are greatest for middle-aged women, the research found that when looking at specific surgeries, Generation X women, ages 35-44, who undergo total knee replacement have an alarming rate of persistent opioid use. Twenty-three percent of women in this age group were found to be using opioids three to six months after their surgery.

“This report validates how the overprescribing of opioids following surgery has become an inadvertent gateway to the growing opioid epidemic,” says Gary Mendell, founder and CEO of Shatterproof, a national nonprofit that supports and advocates for families affected by addiction. “By educating physicians about proper opioid prescribing, and informing physicians and patients of alternate ways to manage postsurgical pain, I’m hopeful we will see fewer families devastated by opioid use.”

The independent analysis conducted by the QuintilesIMS Institute, with funding from Pacira Pharmaceuticals, examined national prescription opioid trends including age, gender and geographical trends in opioid prescribing in 2016, as well as opioid use in the surgical setting in the months prior to and following surgery. The study analyzed the use of opioids for seven specific surgical procedures including colectomy (removal of a portion of the colon), hernia, hysterectomy, rotator cuff surgery, sleeve gastrectomy (a procedure for weight loss), total hip replacement and total knee replacement.

Additional key findings of the research include:                                                    

• Patients undergoing a colectomy and knee replacement surgery have the highest rate of persistent opioid use following surgery, 17.6 percent and 16.7 percent, respectively.
• A 10 percent reduction in surgery-related opioid prescribing would reduce
  • The number of excess postsurgical pills available for diversion or misuse by 332 million
  • The annual number of patients who go on to persistent opioid use after surgery by 300,000
  • Annual drug costs by $830 million
• Including sources other than surgery, 11.7 billion opioid pills were prescribed to Americans in 2016, enough opioids for every man, woman and child to have 36 pills apiece.
  • Rural states have the highest rates of opioid prescribing; Alabama tops the list, with enough opioids prescribed for every resident in the state to have 72 pills each.
  • Almost one in five opioid prescriptions (18 percent) went to patients age 20-39. This population is most likely to abuse these drugs, and accounts for the greatest number of individuals entering treatment for opioid addiction.  

This report is the second phase of a two-year research initiative by Pacira Pharmaceuticals to help better educate patients and prescribers about postsurgical opioid risks. In 2016, in partnership with the American Society of Enhanced Recovery (ASER), Pacira launched the Choices Matter program to promote proactive patient-physician discussions on non-opioid options for treating postsurgical pain. To build on the efforts, this year’s initiative includes a collaboration with former NBA All-Star Grant Hill, who has a history of surgery and has used both opioid and non-opioid options. For more information and to download The United States for Non-Dependence report, visit www.PlanAgainstPain.com.