Researchers find conditions, characterics that raise opioid misuse risk

Aug. 1 (UPI) -- Certain risk factors contribute to opioid misuse, including depression, back pain and previous drug use, according to an analysis of data.

Specific prescribing patterns, surgical procedures and patient characteristics increase the risk of long-term opioid use, which is generally considered longer than two months after surgery or trauma. Researchers and clinicians at Beth Israel Deaconess Medical Center in Boston published their findings Wednesday in The Journal of Bone and Joint Surgery.

Through 2017, they examined 37 studies with more than 1.9 million patients, which they said is the first first meta-analysis of risk factors that places patients at an increased chance for prolonged opioid use.

Race and household income were not significant risk factors for prolonged opioid use, the researchers said.

"Understanding the pooled effect of risk factors can help physicians develop effective and individualized pain management strategies with a lower risk of prolonged opioid use," Dr. Ara Nazarian, a principal investigator in the Center for Advanced Orthopaedic Studies at BIDMC and associate professor of orthopaedic surgery at Harvard Medical School, said in a press release.

About 4 percent of the general patient population will continue using opioids for an extended time period, the researchers found. But among patients with a history of prescription opioid use, nearly a quarter of patients will continue to use prescribed opioids or benzodiazepines for an extended time period after surgery.

"Four percent may not seem like much; however, hospitals have reduced the rate of surgical infections -- another unwanted potential side effect of surgery -- far below 4 percent," said corresponding author Dr. Amin Mohamadi, post-doctoral research fellow in the Nazarian lab. "That demonstrates what's possible with a concerted effort. Our data suggests much more effort is needed in order to mitigate the problem of prolonged opioid use."

They found prior drug use, depression and back pain were among the most important patient-related factors predicting those who would continue to use the medications beyond two months. Antidepressants or non-narcotic pain killers did not appear to increase prolonged opioid use.

"Depression is also highly correlated with chronic post-surgical pain," Mohamadi said. "Our findings suggest that addressing concurrent mental health problems and managing postsurgical pain using multiple modalities including non-narcotic analgesics could mitigate the risk of prolonged use of opioids associated with depression or pain."

They found the highest rates of prolonged opioid use were among patients receiving worker's compensation benefits at 24.6 percent.

Long-term opioid use is also significantly higher among patients treated by high-intensity prescribers.

Because doctors may also avoid the use of non-steroidal anti-inflammatory drugs such as ibuprofen in patients with cardiovascular concerns, the researchers believe that may explain the significant risk factor.

In addition, physicians also tend to prescribe opioids to women more often than men and ultimately their use is greater.

"Providing patients with adequate pain relief, involving patients in pain management planning with realistic goal-setting and providing them with comprehensible information about the risks of opioid use, tapering opioid use prior to hospital discharge and using more uniform prescribing protocols could reduce the overall burden of long-term opioid use following surgery or trauma," Mohamadi said.