According to results published in JAMA Network Open preoperative use of opioids, illicit cocaine use, and pain conditions before surgery have the strongest associations with prolonged opioid use.
A systematic review and meta-analysis of 33 observational studies, totalling over 1.9 million adult patients, found that 7% continued to fill opioid prescriptions more than 3 months after surgery.
The mean age (when reported) was 59.3 years (39.0-80.0). The pooled rate of prolonged opioid use after surgery was 6.7 per cent, with substantial between-study heterogeneity.
Significantly increased risks of prolonged opioid use were observed among females compared to males and among individuals with a high school degree versus a college degree or higher. An increased risk was associated with the use of antidepressants, opioids, benzodiazepines, alcohol, cocaine, or tobacco before surgery.
Increased risks were also associated with participants with diagnoses of anxiety, depression, and mood disorders before surgery and prolonged opioid use after surgery.
Aggregating pain conditions across all studies, prolonged opioid use after surgery was most strongly associated with a history of back pain and fibromyalgia.
These patient-level risk factors may be included in screening at-risk individuals requiring a transition to non-opioid interventions. Further research is needed.