Breaking News
September 22, 2018 - Brigham Genomic Medicine program unravels 30 medical mysteries
September 22, 2018 - New system harnesses power of bubbles to destroy dangerous biofilms
September 22, 2018 - Inflammation plays crucial role in preventing heart attacks and strokes, study reveals
September 22, 2018 - Calorie dense, nutrient deficient meals common across the world
September 22, 2018 - Researchers develop technology to study behavior of implants without animal testing
September 22, 2018 - First gut bacteria in newborns may have lasting effect on ability to ward off chronic diseases
September 22, 2018 - Detection of BFD virus in parrots in 8 new countries raises concerns for threatened species
September 22, 2018 - Insulin treatment shows great potential against chronic bowel inflammation
September 22, 2018 - ‘Liking Gap’ Might Stand in Way of New Friendships
September 22, 2018 - Simple factors that can avoid harmful side effects in type 2 diabetes
September 22, 2018 - ALSAM Foundation invests additional $2 million for drug discovery and development projects
September 22, 2018 - Study findings may advance discussion of how to effectively curb human-wildlife conflict
September 22, 2018 - Dopamine neurons may involve in conditions ranging from Parkinson’s disease to schizophrenia
September 22, 2018 - Protein C and Protein S Tests: MedlinePlus Lab Test Information
September 22, 2018 - Obesity and diabetes—two reasons why we should be worried about the plastics that surround us
September 22, 2018 - Concern over fussy eating prompts parents to use non-responsive feeding practices
September 22, 2018 - Novel mathematical approach uncovers existence of unsuspected biological cycles
September 22, 2018 - Cancer Research UK invests £14 million to transform London into cancer biotherapeutics hub
September 22, 2018 - Scientists predict how well the body will fight lung cancer by analyzing immune cell shapes
September 22, 2018 - New outbreak of rare eye disease identified in contact lens wearers
September 22, 2018 - Iterum Initiates SURE 2 and SURE 3 Phase 3 Clinical Trials of IV and Oral Sulopenem in Complicated Urinary Tract and Complicated Intra-abdominal Infections
September 22, 2018 - Research finds divide in dental health accessibility between city and regional areas
September 22, 2018 - Premature babies show better brain development when fed breast milk, finds study
September 22, 2018 - Novel system uses AI to detect abnormalities in fetal hearts
September 22, 2018 - UNC scientists reveal new approach to prevent obesity and diabetes
September 22, 2018 - CWRU receives NIH grant to learn how non-coding genes contribute to spread of colorectal cancer
September 22, 2018 - Scientists better understand influenza virus and how it spreads
September 22, 2018 - Scientists to focus on length of time when a person is alive and healthy
September 22, 2018 - Study shows positive financial impacts of Medicaid expansion for low-income Michigan residents
September 22, 2018 - Innovative approach for developing vaccine against most prevalent human malaria parasite
September 22, 2018 - Survey estimates caregiving costs for family members
September 22, 2018 - Inhibiting NF-kB improves heart function in a mouse model of Duchenne muscular dystrophy
September 22, 2018 - Introducing new EMR system may affect several aspects of clinic workflow
September 22, 2018 - Study finds why some human genes are more popular with biomedical researchers
September 22, 2018 - Finding epigenetic signature appears to predict inflammation risk in serious type of IBD
September 22, 2018 - Researchers develop light-based technique to measure very weak magnetic fields
September 22, 2018 - UAB researchers study dysfunction of the immune system associated with NSAID carprofen
September 22, 2018 - QIAGEN and DiaSorin launch automated, CE-marked workflow for high-throughput TB screening
September 22, 2018 - EFS checklist provides user-friendly tool for evaluating feeding skills in preterm infants
September 22, 2018 - Family history in blacks, Latinos associated with higher risk of AFib
September 22, 2018 - Researchers identify new genetic disorder in a human patient
September 22, 2018 - Cardiac MR With Contrast Feasible in Developing World
September 22, 2018 - Daily low-dose aspirin doesn’t reduce heart-attack risk in healthy people
September 21, 2018 - Children with asthma found to be disadvantaged in education and future occupation
September 21, 2018 - Interaction of chemical slurry and ancient shale in fracking wastewater causes radioactivity
September 21, 2018 - Scientists use mice to study transmission of Lyme disease bacteria by infected ticks
September 21, 2018 - Researchers find that sample size is key factor determining accuracy of study results
September 21, 2018 - Study shows how the drive to eat overpowers the brain’s signal to stop
September 21, 2018 - 30 Million Americans Now Have Diabetes
September 21, 2018 - Thousands of breast cancer gene variants engineered and analyzed
September 21, 2018 - The current fellowship interview process is cumbersome — Stanford researchers have a better idea
September 21, 2018 - Progenitor cells for human bone and cartilage have been identified
September 21, 2018 - Study reveals new therapeutic target for pediatric tumor-associated intractable epilepsy
September 21, 2018 - SLU’s College professor receives NIH grant to develop I-TEST project
September 21, 2018 - DermTech completes enrollment in clinical study to assess DNA damage and reversal
September 21, 2018 - Grieving patients treated with talk therapy have lower risk of suicide and psychiatric illness
September 21, 2018 - NIH and FDA call for eliminating involvement of RAC in human gene therapy experiments
September 21, 2018 - New system uses algorithm to convert 2D videos into 3D printed ‘motion sculptures’
September 21, 2018 - Sea squirt model reveals key molecules in dopaminergic neuron differentiation
September 21, 2018 - Effective management of neonatal abstinence syndrome requires coordinated ‘cascade of care’
September 21, 2018 - Refugees seek care for wounds of war
September 21, 2018 - Under the sea, in an octopus’ garden on ecstacy
September 21, 2018 - Eating foods with low nutritional quality ratings linked to cancer risk in large European cohort
September 21, 2018 - Giving kids honest information about water consumption may help them make healthy choices
September 21, 2018 - Horwitz Prize Awarded for Work on Hormones
September 21, 2018 - CHMP issues positive opinion supporting use of Trelegy Ellipta in broader group of COPD patients
September 21, 2018 - Scientists discover new molecules that work together to remove unwanted DNA
September 21, 2018 - Dr. Fenella France to deliver 2019 Plenary Lecture
September 21, 2018 - New research finds that MHC-II molecules have more influence on tumors than MHC-I
September 21, 2018 - Researchers study effects of cardiac cycle in simple learning task
September 21, 2018 - FDA takes new steps to address opioid crisis by approving Opioid Analgesic Risk Evaluation and Mitigation Strategy
September 21, 2018 - Positive Barhemsys Phase 3 Treatment Data Published in Anesthesia & Analgesia
September 21, 2018 - Celiac Disease Screening: MedlinePlus Lab Test Information
September 21, 2018 - Autism linked to egg cells’ difficulty creating large proteins
September 21, 2018 - Tweaking nuclear pores could provide new avenue to battle against cancer
September 21, 2018 - Experts warn health care providers to slow down in allowing smart pill in patient care settings
September 21, 2018 - MoreGrasp reports breakthrough development of grasp neuroprosthetics activated by thought control
September 21, 2018 - Study reveals new way to target HER2-negative metastatic breast cancer
September 21, 2018 - CHMP grants positive opinion for VENCLYXTO plus rituximab for treating relapsed/refractory CLL
September 21, 2018 - Study offers solid link between visceral organs and brain’s reward, motivation system
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