Nav: Home

Patients in the US and Canada are likely to receive opioids after surgery

September 04, 2019

PHILADELPHIA -- Patients in the United States and Canada are seven times as likely as those in Sweden to receive a prescription for opioid medications after surgery, according to a new multi-institutional study led by researchers from Penn Medicine. Though the United States and Canada had similar prescription rates, patients in the U.S. were prescribed a much higher dosage - as measured by the total morphine milligram equivalents (MME). The findings were published today in JAMA Network Open.

To compare international opioid prescribing rates after surgery, researchers analyzed data on four frequently performed procedures: surgery to remove the appendix, surgery to remove the gallbladder, a minimally invasive procedure to treat a torn meniscus cartilage in the knee and a procedure to remove a breast lump.

Within seven days of discharge, about 75 percent of the patients in the United States and Canada filled an opioid prescription, compared to just 11 percent of the patients in Sweden. By the one-month mark, nearly half of U.S patients had received high-dose opioid prescriptions (i.e., prescriptions totaling more than 200 MME) - nearly double the rate in Canada (25 percent) and nine times higher than the rate in Sweden (5 percent).

"Our findings reveal stark differences in prescribing practices across the three countries and suggest real opportunities to encourage more judicious use of opioids before and after surgery for patients in the United States and Canada," said the study's corresponding author Mark D. Neuman, MD, an associate professor of Anesthesiology and Critical Care and Chair of the Penn Medicine Opioid Task Force. "While innovative strategies, like enhanced recovery protocols, have helped to reduce the number of prescribed opioids, it's clear that we need to continue to identify ways to improve prescribing practices in the United States and Canada."

Opioids, such as codeine, tramadol and morphine, are routinely prescribed for postoperative pain management in many countries. However, recent research suggests that overprescribing opioid medications for short-term pain may be widespread in the United States. The excessive prescribing can increase the risk of drug diversion, new long-term opioid use and the development of opioid use disorder. In the last decade, opioid overdose deaths have significantly increased in countries across the world, including the United States and Canada - which have the highest opioid use per capita in the world.

While the use of opioids varies in countries worldwide, there has been little research - until now - that characterizes the international disparities in opioid use for specific indications, such as pain relief after surgery. In their analysis, researchers examined data from more than 220,000 cases - ranging from 2013 to 2016 - to identify differences in the percentage of opioid prescriptions filled within seven and 30 days of the procedures, as well as the quantity and types of opioids dispensed. They specifically sought patients who shared similar characteristics, including age and medical history, and who had not received an opioid in the 90 days prior to the surgery.

Researchers found that at least 65 percent of patients in the United States and Canada filled an opioid prescription in the first seven days after each procedure. In Sweden, the prescribing rate didn't exceed 20 percent for any of the procedures. Meanwhile, the average dosage of the initial prescription in the United States was 247 MME -much higher than the dosage dispensed in Sweden (197) and Canada (169). In addition to the disparities in prescribing rate and dosage, researchers also identified a significant variation in the types of opioid medication prescribed. For example, codeine and tramadol accounted for 58 percent of the postoperative prescriptions dispensed in Canada and 45 percent of the prescriptions in Sweden, but just 7 percent of prescriptions in the United States. In the United States, hydrocodone and oxycodone were the most commonly dispensed opioid medications.

"Our findings point to systematic differences in practitioners' approaches to opioid prescribing, public attitudes regarding the role of opioids in treating pain and broader structural factors related to drug marketing and regulation," said Dr. Karim Ladha, a clinician-scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and co-author of the study.
-end-
The work was supported, in part, by a grant from the National Institutes of Health (1-R01-DA042299) and ICES.

Additional Penn Medicine authors include Lakisha J. Gaskins, MHS, Craig W. Newcomb, MS, and Colleen M. Brensinger, MS.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $7.8 billion enterprise.

The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $425 million awarded in the 2018 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center--which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report--Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation's first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Home Care and Hospice Services, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is powered by a talented and dedicated workforce of more than 40,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2018, Penn Medicine provided more than $525 million to benefit our community.

University of Pennsylvania School of Medicine

Related Opioids Articles:

Of all professions, construction workers most likely to use opioids and cocaine
Construction workers are more likely to use drugs than workers in other professions, finds a study by the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU College of Global Public Health.
US-born residents more than 5 times likely to use prescription opioids than new immigrants
The longer immigrants live in the United States, the more likely they are to use prescription opioids -- a fact that contradicts popular views linking wealth and health, and suggests that American culture is uniquely favorable toward prescribing opioids.
Opioids often prescribed after cesarean delivery even when not needed
Nearly 90% of women who did not use opioids in the hospital after cesarean delivery were nonetheless discharged with a prescription for opioids, according to a study presented at the ANESTHESIOLOGY® 2019 annual meeting.
Kidney function may affect risks associated with prescription opioids
Compared with other pain medications, prescription opioids were linked with higher risks of death and hospitalization, particularly with higher doses.
Nearly 1 in 3 patients with lupus use prescription opioids for pain
A new study finds nearly one in three adults with lupus use prescription opioids to manage pain, despite a lack of evidence that opioids are effective for reducing pain from rheumatic diseases.
Patients in the US and Canada are likely to receive opioids after surgery
Patients in the United States and Canada are seven times as likely as those in Sweden to receive a prescription for opioid medications after surgery, according to a new multi-institutional study led by researchers from Penn Medicine.
Six in 10 children receive opioids after tonsillectomy
Sixty percent of privately insured children undergoing tonsil removal received opioids -- with average prescriptions lasting about six to 10 days -- a new study finds.
Reducing exposure to opioids after cesarean delivery
An effort to improve the scheduled cesarean section delivery experience found that changes to preoperative and postoperative processes can lead to reductions in opioid use without increased pain and with faster recovery, according to research from Kaiser Permanente published in the journal Obstetrics & Gynecology.
Prescribed opioids associated with overdose risk for family members without prescriptions
Access to family members' drugs may be a strong risk factor for overdose in individuals without their own prescriptions, according to a new study by investigators from Brigham and Women's Hospital.
Prescribing opioids for a sprained ankle?
A new research report shows an increase in patients being prescribed opioids after experiencing an ankle sprain.
More Opioids News and Opioids 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.