Cutting Through the Pain: Study Exploring Opioid Use in Post-Surgical Cancer Patients

Recent study investigates opioid prescribing patterns among opioid-naïve patients after surgeries for breast, gynecologic, and head and neck cancers, focusing on identifying overprescribing and its predictors. Conducted at a cancer referral hospital, the research included 119 patients, ultimately analyzing 107 after screening. Participants were opioid-naïve if they had minimal opioid exposure prior to surgery, with a defined duration of less than seven days and dosage not exceeding 30 mg oral morphine equivalent daily.

Outcomes of Overprescribing Assessment

The primary outcome assessed the prevalence of opioid overprescribing, defined as patients utilizing less than 50% of the prescribed opioids within the first week post-discharge. The secondary outcome identified predictors of this overprescribing through multivariable Poisson regression. Results indicated that 55% of patients were overprescribed opioids. These individuals exhibited significantly lower pain scores at discharge, greater quantities of opioids prescribed, and a notable percentage had not used opioids in the 24 hours preceding discharge.

Findings on Overprescribing Risks

Key findings exposed that the risk of overprescribing increased significantly—2.4 times greater—for patients receiving prescriptions without prior opioid use and 1.7 times for those on opioids 24 hours before discharge supplied with more than five equivalent days of opioids. The study outlines a clear disconnect between opioid prescribing practices and actual patient needs post-surgery.

Trends and Recommendations for Prescribing

Moreover, patients prescribed extended durations of opioids were likely to have leftover doses, with 39% of overprescribed patients reporting no prior use. These trends came despite guidelines advocating for individualized prescriptions that align better with patient consumption levels. Recommendations emphasized the necessity for tailored opioid prescriptions based on immediate post-surgical requirements and the importance of limiting prescriptions to less than five days to mitigate risks of overuse and potential dependency.

Implications for Patient Care

The implications are critical in addressing the epidemic of opioid overprescribing in surgery contexts, where inappropriate prescribing can lead to long-term negative consequences for patient health. The study advocates for enhanced awareness and training among surgical teams to refine opioid prescription practices, underlining a need for patient-centered approaches in analgesic management. It also highlights the potential benefits of a structured follow-up system to monitor opioid use and support informed decision-making regarding pain management. Overall, these findings underline the urgency of addressing overprescribing to protect patient welfare in post-operative care environments.

Key Points

- The study analyzed opioid prescribing patterns among 119 opioid-naïve patients after surgeries for breast, gynecologic, and head and neck cancers, ultimately focusing on 107 patients who met the inclusion criteria of minimal prior opioid exposure (less than seven days and not exceeding 30 mg oral morphine equivalent daily).

- A primary outcome measured the prevalence of opioid overprescribing, evident in 55% of patients who used less than 50% of prescribed opioids within the first week after discharge. Secondary outcomes included identifying predictors of overprescribing through multivariable Poisson regression analysis.

- Risk factors for opioid overprescribing were identified, revealing that patients without prior opioid use had a 2.4 times higher likelihood of overprescribing, while those on opioids 24 hours before discharge and receiving over five days' worth of drugs had a 1.7 times higher risk.

- Overprescribed patients reported a significant level of unused medication post-surgery, with 39% indicating no prior opioid use. These findings highlight a disconnect between the opioid supply prescribed and the actual consumption needs of patients post-discharge.

- Recommendations derived from the study advocate for individualized opioid prescriptions that align more closely with individual patient needs, suggesting a limitation of prescriptions to less than five days to reduce risks associated with overuse and dependency.

- The study emphasizes the urgent need for improved opioid prescribing practices within surgical settings, promoting enhanced training for surgical teams and advocating for patient-centered approaches in managing postoperative pain, as well as the importance of follow-up systems to monitor opioid usage and support informed clinical decisions.

Reference –

Kenny Kwon Ho Lee et al. (2024). The Prevalence And Predictors Of Discharge Opioid Overprescribing In Opioid-NaïVe Patients After Breast, Gynecologic, And Head And Neck Cancer Surgery: A Prospective Cohort Study. *Canadian Journal Of Anaesthesia*, 72, 132 - 141. https://doi.org/10.1007/s12630-024-02819-w.