Chronic Use of Opioid Medications Before and After Bariatric Surgery

Abstract

IMPORTANCE Obesity is associated with chronic noncancer pain. It is not known if opioid use for chronic pain in obese individuals undergoing bariatric surgery is reduced.OBJECTIVES To determine opioid use following bariatric surgery in patients using opioids chronically for pain control prior to their surgery and to determine the effect of preoperative depression, chronic pain, or postoperative changes in body mass index (BMI) on changes in postoperative chronic opioid use. DESIGN, SETTING, AND PARTICIPANTSRetrospective cohort study in a distributed health network (10 demographically and geographically varied US health care systems) of 11 719 individuals aged 21 years and older, who had undergone bariatric surgery between 2005 and 2009, and were assessed 1 year before and after surgery, with latest follow-up by December 31, 2010.MAIN OUTCOMES AND MEASURES Opioid use, measured as morphine equivalents 1 year before and 1 year after surgery, excluding the first 30 postoperative days. Chronic opioid use is defined as 10 or more opioid dispensings over 90 or more days or as dispensings of at least a 120-day supply of opioids during the year prior to surgery. RESULTS Before surgery, 8% (95% CI, 7%-8%; n = 933) of bariatric patients were chronic opioid users. Of these individuals, 77% (95% CI, 75%-80%; n = 723) continued chronic opioid use in the year following surgery. Mean daily morphine equivalents for the 933 bariatric patients who were chronic opioid users before surgery were 45.0 mg (95% CI, 40.0-50.1) preoperatively and 51.9 mg (95% CI, 46.0-57.8) postoperatively (P < .001). For this group with chronic opiate use prior to surgery, change in morphine equivalents before vs after surgery did not differ between individuals with loss of more than 50% excess BMI vs those with 50% or less (>50% BMI loss: adjusted incidence rate ratio [adjusted IRR, 1.17; 95% CI, 1.07-1.28] vs Յ50% BMI loss [adjusted IRR, 1.03; 95% CI, 0.93-1.14] model interaction, P = .06). In other subgroup analyses of preoperative chronic opioid users, changes in morphine equivalents before vs after surgery did not differ between those with or without preoperative diagnosis of depression or chronic pain (depression only [n = 75; IRR, 1.08; 95% CI, 0.90-1.30]; chronic pain only [n = 440; IRR, 1.17; 95% CI, 1.08-1.27]; both depression and chronic pain [n = 226; IRR, 1.11; 95% CI, 0.96-1.28]; neither depression nor chronic pain [n = 192; IRR, 1.22; 95% CI, 0.98-1.51); and P values for model interactions when compared with neither were P = .42 for depression, P = .76 for pain, and P = .48 for both. CONCLUSIONS AND RELEVANCEIn this cohort of patients who underwent bariatric surgery, 77% of patients who were chronic opioid users before surgery continued chronic opioid use in the year following surgery, and the amount of chronic opioid use was greater postoperatively than preoperatively. These findings suggest the need for better pain management in these patients following surgery.

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…Prior studies examining chronic opioid use after surgery demonstrated similar findings. 61,67,68 Our study was unique because we included both surgical and medical patients in our analysis. Surgical and medical patients with opioid receipt at discharge were more likely to progress to chronic opioid use; however, there was a larger effect for medical patients on chronic opioid use.…”

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

“…We identified current smokers as patients with electronic health record (EHR) flags indicating current tobacco use or prior-year visits with tobacco use disorder diagnoses (ICD-9-CM code 305.1). 36 For descriptive purposes, we used ICD-9-CM codes 37 to identify pain diagnoses for past-year visits.…”

A psychiatric perspective view of bariatric surgery patients

“…In a study conducted to determine opioid use following bariatric surgery in patients using opioids chronically for pain control prior to their surgery, 77% of them continued chronic opioid use in the year following surgery and the amount of opioid substance was greater postoperatively than preoperatively 92 . One possible explanation is that some patients likely had pain unresponsive to weight loss but potentially responsive to opioids.…”