Nav: Home

One in 5 surgical weight-loss patients take prescription opioids 7 years after surgery

June 05, 2017

PITTSBURGH, June 5, 2017 - While the proportion of adults with severe obesity using prescription opioids initially declines in the months after bariatric surgery, it increases within a matter of years, eventually surpassing pre-surgery rates of patients using the potentially addictive pain medications, according to new research from a National Institutes of Health (NIH)-funded multicenter study led by the University of Pittsburgh Graduate School of Public Health.

The findings--which come from one of the largest, longest-running studies of adults who underwent weight-loss surgery--indicate that improvements in obesity-related pain gained through bariatric surgery are not sufficient to counter the need for pain relief in the years following the procedure. Results are reported today in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery.

"Almost half of patients reporting opioid use at the time of surgery reported no such use following surgery. However, among the much larger group of patients who did not report opioid use pre-surgery, opioid use gradually increased throughout seven years of follow-up," said lead author Wendy C. King, Ph.D., associate professor of epidemiology at Pitt Public Health. "Thus, post-surgery initiation of opioid use explains this phenomenon."

The U.S. Centers for Disease Control and Prevention recently presented an evidence-based guideline stating that opioids should not routinely be used to manage chronic pain.

"Our nation is in an epidemic of opioid abuse, addiction and overdose. Recent reports have suggested that bariatric surgery patients are at elevated risk of chronic opioid use," said co-author Anita P. Courcoulas, M.D., M.P.H., chief of minimally invasive bariatric and general surgery at UPMC. "Our study does not prove that bariatric surgery causes an increase in opioid use. However, it does demonstrate the widespread use of opioids among post-surgical patients, thereby highlighting the need for alternative pain management approaches in this population."

Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the NIH-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States.

About 70 percent of the patients underwent Roux-en-Y gastric bypass (RYGB), a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine. The majority of the remaining participants had a less invasive procedure, laparoscopic adjustable gastric banding, where the surgeon inserts an adjustable band around the patient's stomach, lessening the amount of food the stomach can hold.

Before surgery, 14.7 percent of the participants reported regularly taking a prescription opioid. Six months after surgery the prevalence decreased to 12.9 percent, but then it rebounded, progressing to 20.3 percent of participants regularly taking opioids seven years after surgery. Among participants who were not taking opioids at the time of surgery, rates increased from 5.8 percent six months after surgery to 14.2 percent seven years later. Hydrocodone was by far the most commonly reported opioid medication, followed by Tramadol and Oxycodone.

There also was an increase over time in the use of medications typically prescribed for opioid dependence, although use of such medications remained rare, with less than 2 percent of patients using them through the years of follow-up.

Recently, King and her colleagues reported that undergoing RYGB, compared to gastric banding, was related to increased risk of alcohol use disorder, illicit drug use and treatment for substance use disorder following surgery. However, in this study, the risk of starting or continuing opioid use post-surgery did not differ by surgical procedure.

Most factors related to substance use disorder that were examined--such as gender, age, income, social support, mental health, smoking, alcohol consumption and illicit drug use--were not related to continued or post-surgery opioid use. However, more pain before surgery, worsening or less of an improvement in pain following surgery, and starting or continuing non-opioid pain-killers were each associated with a higher risk of continuing or starting opioid use after surgery.

Some researchers have hypothesized that opioid use increases following bariatric surgery due to discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which are contraindicated post-surgery. However, King and her colleagues found that starting NSAIDs post-surgery was associated with a higher risk of also starting to take opioids, while stopping NSAIDs was associated with lower risk of taking opioids.

"This likely reflects that opioid and non-opioid pain-relief medications often are used in tandem, versus as alternatives to each other," said King. "There is an urgent need for research into adequate alternatives to opioids for the long-term management of chronic pain following weight-loss surgery."
-end-
Additional authors on this study are Jia-Yuh Chen, Ph.D., and Steven Belle, Ph.D., both of Pitt Public Health; Gregory F. Dakin, M.D., of Weill Cornell Medical College; Scott G. Engel, Ph.D., and James E. Mitchell, M.D., both of the Neuropsychiatric Research Institute in Fargo, N.D.; David R. Flum, M.D., and Marcelo W. Hinojosa, M.D., both of the University of Washington; Melissa A. Kalarchian, Ph.D., of Pitt and Duquesne University; Bruce M. Wolfe, M.D., of the Oregon Health Sciences University; Walter J. Pories, M.D., and Konstantinos Spaniolas, M.D., both of East Carolina University; Kristine J. Steffen, Pharm.D., Ph.D., of the Neuropsychiatric Research Institute and North Dakota State University; and Susan Z. Yanovski, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the NIH.

This clinical study was a cooperative agreement funded by the NIDDK. Grant numbers are: Data Coordinating Center - U01 DK066557; Columbia-Presbyterian - U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, grant UL1-RR024996); University of Washington - U01-DK66568 (in collaboration with CTRC, grant M01RR-00037); Neuropsychiatric Research Institute - U01-DK66471; East Carolina University - U01-DK66526; UPMC - U01-DK66585 (in collaboration with CTRC, grant UL1-RR024153); and Oregon Health & Science University - U01-DK66555.

About the University of Pittsburgh Graduate School of Public Health

The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school's Web site at http://www.publichealth.pitt.edu.

http://www.upmc.com/media

Contact: Allison Hydzik
Office: 412-647-9975
Mobile: 412-559-2431
E-mail: HydzikAM@upmc.edu

Contact: Amy Charley
Office: 412-586-9778
Mobile: 412-738-3511
E-mail: CharleyA@upmc.edu

University of Pittsburgh Schools of the Health Sciences

Related Public Health Articles:

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.
Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.
Bloomberg American Health Initiative releases special public health reports supplement
With US life expectancy now on the decline for two consecutive years, the Bloomberg American Health Initiative is releasing a supplement to Public Health Reports, the scholarly journal of the US Surgeon General.
Data does the heavy lifting: Encouraging new public health approaches to promote the health benefits of muscle-strengthening exercise (MSE)
According to a new study in the American Journal of Preventive Medicine, almost 75 percent of US adults do not comply with public health guidelines recommending two or more muscle-strengthening exercise (MSE) sessions a week, with nearly 60 percent of the population doing no MSE at all.
The Lancet Public Health: Moderate carbohydrate intake may be best for health
Low-carb diets that replace carbohydrates with proteins and fats from plant sources associated with lower risk of mortality compared to those that replace carbohydrates with proteins and fat from animal sources.
Mass. public safety, public health agencies collaborate to address the opioid epidemic
A new study shows that public health and public safety agencies established local, collaborative programs in Massachusetts to connect overdose survivors and their personal networks with addiction treatment, harm reduction, and other community support services following a non-fatal overdose.
Cyber attacks can threaten public health
Gordon and Landman have authored a Perspective piece in the New England Journal of Medicine that addresses the growing threat of attacks on information systems and the potential implications on public health.
Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
More Public Health News and Public Health Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#540 Specialize? Or Generalize?
Ever been called a "jack of all trades, master of none"? The world loves to elevate specialists, people who drill deep into a single topic. Those people are great. But there's a place for generalists too, argues David Epstein. Jacks of all trades are often more successful than specialists. And he's got science to back it up. We talk with Epstein about his latest book, "Range: Why Generalists Triumph in a Specialized World".
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.