Substance use after bariatric surgery: A review

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Background Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) following bariatric surgery is limited. Objective To report SUD-related outcomes following RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. Setting Ten US hospitals. Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to seven years through January 2015. Results Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95%CI, 18.5-23.3), 7.5% (95%CI, 6.1-9.1), and 3.5% (95%CI, 2.6-4.8), respectively, post-RYGB, and 11.3% (95%CI, 8.5-14.9), 4.9% (95%CI, 3.1-7.6), and 0.9% (95%CI, 0.4-2.5) post-LAGB. Undergoing RYGB vs. LAGB was associated with higher risk of incident AUD symptoms (AHR=2.08 [95%CI, 1.51-2.85]), illicit drug use (AHR=1.76 [95%CI, 1.07-2.90]) and SUD treatment (AHR=3.56 [95%CI, 1.26-10.07]). Conclusions Undergoing RYGB vs. LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.

Section: Introductionmentioning

confidence: 99%

Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

King

Chen

Courcoulas

et al. 2017

217

154

“…An epidemic of opioid abuse, addiction and overdose has been an unforeseen consequence(5). Given recent reports suggesting several surgical procedures are associated with an increased risk of chronic opioid use(6), coupled with evidence that bariatric surgery patients are overrepresented in substance use treatment facilities and that Roux-en-Y Gastric Bypass (RYGB) increases the risk of alcohol use disorder(7), there is growing concern over opioid analgesic use among bariatric surgery patients.…”

Section: Introductionmentioning

confidence: 99%

Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

King

Chen

Belle

et al. 2017

Background Limited evidence suggests bariatric surgery may not reduce opioid analgesic use, despite improvements in pain. Objective To determine if use of prescribed opioid analgesics changes in the short- and long-term following bariatric surgery and to identify factors associated with continued and post-surgery initiated use. Setting Ten US hospitals. Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Assessments were conducted pre-surgery, 6 months post-surgery and annually post-surgery for up to 7 years until January 2015. Opioid use was defined as self-reported daily, weekly or “as needed” use of a prescribed medication classified as an opioid analgesic. Results Of 2258 participants with baseline data, 2218 completed follow-up assessment(s) (78.7% were female, median body mass index 46; 70.6% underwent Roux-en-Y gastric bypass). Prevalence of opioid use decreased following surgery from 14.7% (95% CI, 13.3–16.2) at baseline to 12.9% (95% CI, 11.5–14.4) at month-6, but then increased to higher than baseline levels as time progressed to 20.3% (95% CI, 18.2–22.5) at year-7. Among participants without baseline opioid use (N=1892), opioid use prevalence increased from 5.8% (95% CI, 4.7–6.9) at month-6 to 14.2% (95%CI, 12.2–16.3) at year-7. Public versus private health insurance, more pain pre-surgery, undergoing subsequent surgeries, worsening/less improvement in pain, and starting or continuing non-opioid analgesics post-surgery were significantly associated with higher risk of post-surgery initiated opioid use. Conclusion Following bariatric surgery, prevalence of prescribed opioid analgesic use initially decreased, but then increased, surpassing baseline prevalence, suggesting the need for alternative methods of pain management in this population.

“…2,3 Data characterizing links between adult alcohol use behavior and weight loss outcomes are equivocal. 5,6 Finally, increased alcohol sensitivity occurs post-operatively, particularly for Roux-en-Y gastric bypass (RYGB) patients, including increased rate of absorption and serum peak levels, intoxication, perceived drunkenness, and in some work, a longer elimination half-life from the bloodstream. 7–10 Recognizing our understanding of alcohol metabolism following sleeve gastrectomy is far more limited, 11,12 these alcohol-related outcomes are clinical safety concerns.…”

Section: Introductionmentioning

confidence: 99%

Alcohol use risk in adolescents 2 years after bariatric surgery

Zeller

Washington

Mitchell

et al. 2017

Background Problematic alcohol use and increased sensitivity post-operatively in adult weight loss surgery (WLS) patients heightens concerns. No data have characterized these behaviors in adolescents, a gap given adolescent alcohol use and heavy drinking are public health concerns. Setting Five academic medical centers. Methods Utilizing a prospective controlled design, adolescents undergoing WLS (n=242) and non-surgical adolescents with severe obesity (n=83) completed the Alcohol Use Disorders Test. Analyses included 216 surgical (Mage=17.1+1.5, MBMI=52.9+9.3, 91.8% female, 67.6% White) and 79 non-surgical participants (Mage=16.2+1.4, MBMI= 46.9+6.1, 82.3% female, 53.2% White) with baseline data and at 12- or 24-months post-operatively. Results The majority reported “never” consuming alcohol within the year prior to surgery (surgical: 92%, non-surgical: 91%) or by 24-months (surgical: 71%, non-surgical: 74%), when alcohol use disorder (AUD) approached 9%. Among alcohol users at 24 months (n=52 surgical, n=17 non-surgical), 35% surgical and 29% non-surgical consumed 3+ drinks on a typical drinking day; 42% surgical and 35% non-surgical consumed 6+ drinks on at least one occasion. For the surgical group, alcohol use changed as a function of older age (OR=2.47, p=0.01) and lower BMI (OR=0.94, p<0.001). Greater percent change in weight (0–24 months) was associated with increased odds of alcohol use at 24 months (OR=1.01, 95% CI: 1.002–1.02). Conclusions Alcohol use was lower than national base rates. AUD rates and harmful consumption raise concerns given extant adult literature. Alcohol education focused on harm reduction (i.e., lower consumption, managing situations conducive to alcohol-related harm) and monitoring by healthcare providers as patients mature is indicated.