Breaking News
March 20, 2018 - Epidural stimulation can safely, effectively normalize blood pressure in patients with SCI
March 20, 2018 - ‘Fast track’ project shows promising results in cancer whole genome analyses
March 20, 2018 - Advanced insulin pump system can also manage type 1 diabetes in children, study shows
March 20, 2018 - Flu risk less on flights if in a window seat finds study
March 20, 2018 - Sarepta Therapeutics Announces Plan to Submit a New Drug Application (NDA) for Accelerated Approval of Golodirsen (SRP-4053) in Patients with Duchenne Muscular Dystrophy (DMD) Amenable to Skipping Exon 53
March 20, 2018 - Post-Transplant Fatty Liver Disease on the Rise
March 20, 2018 - New mutation linked to ovarian cancer can be passed down through dad
March 20, 2018 - Scotland study aims to offer precise diagnoses for people with rare genetic diseases
March 20, 2018 - Stem cell treatment may help rejuvenate ovaries, avoid effects of premature menopause
March 20, 2018 - FDA Approves Hizentra (Immune Globulin Subcutaneous [Human] 20% Liquid) for the Treatment of Patients With Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
March 20, 2018 - Death Strikes Young in RA
March 20, 2018 - Quiescent cells also mutate
March 20, 2018 - Stem cell-derived ocular cells treat severe AMD
March 20, 2018 - Mediterranean diet appears to be good for postmenopausal women’s bones and muscles
March 20, 2018 - Scientists discover rare childhood liver cancer’s ability to metastasize to the brain
March 20, 2018 - Treating metastatic breast cancer with immunotherapy
March 20, 2018 - The 5:2 diet could have beneficial impact on important risk markers for cardiovascular disease
March 20, 2018 - Congress tackles the opioid epidemic. But how much will it help?
March 20, 2018 - Neanderthals Just Part of the Evolutionary Puzzle
March 20, 2018 - Higher Mortality With Surgery for Early NSCLC
March 20, 2018 - Researchers go skin deep to explore what causes wrinkles
March 20, 2018 - E-cigarette use linked to fat accumulation in the liver
March 20, 2018 - Fearful worms provide new clues about human anxiety
March 20, 2018 - Oral micronized progesterone may reduce hot flashes, night sweats in perimenopausal women
March 20, 2018 - Newer treatment for type 2 diabetes reduces liver fat in patients with NAFLD
March 20, 2018 - I.D. Break: PrEP Map; Faulty Flu Meds; Better Zika Test?
March 20, 2018 - Bronchial thermoplasty can improve severe asthmatic cough
March 19, 2018 - Speeding up wound healing using nanofiber dressings
March 19, 2018 - Summit Announces New Analysis Showing Ezutromid Significantly Reduced Muscle Inflammation in Phase 2 Clinical Trial in DMD
March 19, 2018 - Optimizing Sham Acupuncture: That’s Improbable!
March 19, 2018 - Women who have gestational diabetes in pregnancy are at higher risk of future health issues
March 19, 2018 - Viagra cuts colorectal cancer risk in animal model
March 19, 2018 - Vitamin B12 supplementation could postpone disease progression in Parkinson’s patients
March 19, 2018 - Study shows that omega-6 fatty acids could protect against premature death
March 19, 2018 - TherapeuticsMD Announces FDA Acceptance of New Drug Application (NDA) and Prescription Drug User Fee Act (PDUFA) Date for TX-001HR
March 19, 2018 - Minorities More Sensitive To Pain? Pain Medicine News Report
March 19, 2018 - Low blood sugar poses unaddressed threat to people with type 2 diabetes
March 19, 2018 - ACEA goes live with exhaustive, searchable library of NovoCyte publications
March 19, 2018 - Consumption of low-calorie sweeteners could promote metabolic syndrome, increase diabetes risk
March 19, 2018 - Wearable medical patch shows promise for early detection of hypoglycemia in type 1 diabetes
March 19, 2018 - High-energy breakfast leads to better diabetes control and weight loss
March 19, 2018 - D.C. Week: Community Health Centers Get Azar’s Love
March 19, 2018 - Younger siblings of SIDS victims have four-fold increased risk of sudden death
March 19, 2018 - Toothpaste alone does not prevent dental erosion or hypersensitivity
March 19, 2018 - Discovery aids understanding of amyotrophic lateral sclerosis
March 19, 2018 - Hormone imbalance may be reason for higher diabetes rates among men with insufficient sleep
March 19, 2018 - Docs worry there’s ‘nowhere to send’ new and expectant moms with depression
March 19, 2018 - Obesity linked to increased DNA damage in breast epithelium of BRCA mutation carriers
March 19, 2018 - Heart rate increases with higher alcohol consumption
March 19, 2018 - Template produced for clinically validated DIY stethoscope
March 19, 2018 - Experts highlight nocturia as most common cause of poor night’s sleep
March 19, 2018 - Fit Middle-Aged Women May Fend Off Dementia Later
March 19, 2018 - Fake Insta Doc; Humana’s Weird Pay Bump Tax Trick; Few NPDB Searches
March 19, 2018 - Guidelines for fluoride intake—are they appropriate?
March 19, 2018 - Race and pre-pregnancy BMI may be key predictors of maternal weight gain
March 19, 2018 - Telediabetes program improves blood sugar control for veterans
March 19, 2018 - Research suggests breastfeeding as protective factor against obesity in high-birthweight infants
March 19, 2018 - Morning Break: House Nixes ‘Right-to-Try’ Bill; Purdue’s PR Makeover; Air in the Brain
March 19, 2018 - Heart researchers develop a new, promising imaging technique for cardiac arrhythmias
March 19, 2018 - Mice study shows how BPA exposure during pregnancy can lead to altered brain development
March 19, 2018 - Breastfeeding mothers who overeat may increase risk of health problems in offspring
March 19, 2018 - New mobile application can detect atrial fibrillation that causes strokes
March 19, 2018 - Study finds low rates of preconception counseling among women of childbearing age with diabetes
March 19, 2018 - Vitl Life Science Solutions announces launch of new Lu-mini at analytica 2018
March 19, 2018 - ObsEva SA Reports Positive Topline Results from IMPLANT2 Phase 3 Clinical Trial of Nolasiban in IVF
March 19, 2018 - D.C. Week: States Plead for Federal $$ in Opioid Fight
March 19, 2018 - Polycystic ovary syndrome – Genetics Home Reference
March 19, 2018 - Reducing co-payments improves patient, physician adherence to guideline-recommended treatment post-MI
March 19, 2018 - Normalizing estrogen levels can benefit female athletes with irregular menstrual periods
March 19, 2018 - Fitness trackers and virtual coaches motivate patients to exercise post cardiac rehab
March 19, 2018 - Atrial fibrillation patients could reduce risk of dementia by taking stroke prevention drugs
March 19, 2018 - Low sperm count more prevalent with other health problems finds study
March 19, 2018 - Male birth control pill taken once a day shows success
March 19, 2018 - AcelRx Announces Receipt of Type A FDA Meeting Minutes and Plans to Resubmit the DSUVIA New Drug Application in Q2 2018
March 19, 2018 - Eye Docs Adopt EHRs Despite Reservations
March 19, 2018 - CRISPR enhances cancer immunotherapy
March 19, 2018 - Study finds first evidence of delayed aging among Americans
March 19, 2018 - Aussies unaware of sun protection rules to prevent skin cancer
March 19, 2018 - Essential oils linked to abnormal breast development in boys
March 19, 2018 - ‘Tummy Tuck’ Relieved Postpartum Back Pain/Incontinence
New study investigates extent of opioid dependence and overdose in postoperative patients

New study investigates extent of opioid dependence and overdose in postoperative patients

image_pdfDownload PDFimage_print

Drug overdose was the leading cause of accidental death in the U.S. in 2015. Although pain management after surgery continues to rely on opioids, there are concerns that ubiquitous use of opioids has led to a growing epidemic of addiction, dependence, and overdose (ODO). In a new study in The Journal of Urology®, researchers investigated to what extent patients who had undergone urological surgery later became opioid dependent or overdosed. Although the overall risk was low (0.09%, about 1 in 1,111 patients), several risk factors for ODO were identified.

According to the study results, risk factors for ODO include younger age, inpatient surgery and increasing hospitalization duration, baseline depression, tobacco use, and chronic obstructive pulmonary disease. In addition, insurance provider, Medicaid or Medicare enrollment, and noninsured status were factors associated with ODO risk. The investigators also correlated ODO rates to specific urological surgical procedures, with stone procedures (0.15%) or major renal surgery (0.12%) having the highest rates, and major pelvic surgery (0.03%) and inguinal/scrotal procedures (0.05%) having the lowest rates.

“Using these risk factors, we can identify patients at the highest risk for ODO, and tailor specific pain and followup regimens for them that carry the least consequences,” explained lead investigator Gopal N. Gupta, MD, of the Department of Urology, Loyola University Medical Center. “Perhaps the greatest and most rapid impact can be made if physicians reduce over prescription of opioids and seek alternative pain management strategies. Vigilant monitoring of aberrant behavior such as early refill requests, treatment noncompliance, and reports of lost or stolen prescriptions will improve the recognition of signs of abuse.”

Using data from 2007 to 2011 for more than 675,000 patients from the Healthcare Cost and Utilization Project (HCUP) for California that included information on patient discharge, outpatient surgeries, and emergency department records, researchers were able to link surgical records to postoperative diagnoses of ODO occurring within one year of surgery.

Comparing patients in whom ODO did or did not occur, those who overdosed were younger (median age 50 vs 62 years), more likely to be Caucasian (63.4% vs 57.3%) or African American (9.5% vs 3.6%), and less likely to have undergone ambulatory surgery (18.0% vs 57.8%) compared to patients who did not overdose. Patients who overdosed were more likely to have been diagnosed with depression (15.0% vs 3.4%) or be a tobacco user (28.2% vs 15.7%), and less likely to have cancer (17.2% vs 22.8%).

For patients younger than 65 years who were on Medicare or Medicaid, and individuals who self-paid for insurance, the risk of ODO was 2.1 to 3.0 times higher than patients with private insurance. Medicare patients 65 years old or older were not found to be at increased risk for ODO.

In a Commentary in the same issue, Michael S. Leapman, MD, of the Department of Urology, Yale University School of Medicine, and Steven A. Kaplan, MD, of the Department of Urology, Icahn School of Medicine at Mount Sinai, offer some perspective on separating fact from fiction about opioid use in urology.

“Opioid prescription is as deeply entrenched in the rituals of surgery as the act of donning gown and gloves. The ability to perform surgical interventions has always depended on the availability of analgesia, and opioids have long represented an indispensable component of care,” they write. Yet, with many studies showing the variation and extent of high dose opioid prescriptions and persistent use after surgery, there is a concern that urologists might be contributing to the opioid crisis.

Drs. Leapman and Kaplan note that the study suggests that even brief exposures to opioids may result in problems for a minority of patients. But they also suggest that there are physicians who routinely dispense doses well in excess of recommended safety thresholds, patients who obtain multiple prescriptions within short periods (“doctor shopping”), and a confusing set of messages about pain management over recent years.

Dr. Leapman and Dr. Kaplan recommend that, “As attitudes toward opioids are rapidly changing, a balance must be struck between highly restrictive and overzealous prescribing. In light of sobering national statistics of misuse, all clinicians are tasked to embrace responsible prescribing. A middle ground appears possible that reeducates toward demystifying dosing strategies, maximizing patient safety, and preserving a clinician’s judgment.”

Tagged with:

About author

Related Articles