Stopping opioid-related addiction, harm and accidents after surgery

October 07, 2020

The opioid crisis, in which addiction and harm are related to pain-relieving opioid drugs, has been well documented. It has been concentrated in the USA but is now affecting most Western nations and increasingly, developing countries also. In some cases, this addiction and subsequent harm begins when the patient is given these drugs for pain relief after surgery.

To help confront this, an international group of global experts including anaesthetists, surgeons and other healthcare professionals have come together to publish a consensus statement on the prevention of opioid-related harm in adult surgical patients. The consensus statement is published in Anaesthesia (a journal of the Association of Anaesthetists).

"Opioids are effective medicines that form an integral component of balanced multimodal painkilling strategies for the management of acute pain in postoperative patients," explain the statement co-authors, who include Professor Dileep Lobo, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK. "However, over the past decade it has been increasingly appreciated that, in efforts to improve pain relief after surgery, doctors prescribing these drugs to help pain relief during and after surgery have unwittingly contributed to persistent postoperative opioid use, abuse and harm in some patients."

They add: "In addition to the social and economic costs of opioid misuse, there are personal costs, with many people dying from opioid overdose, or in accidents caused, for example, by driving under the influence of opioids."

Ways to reduce possible harm begin before surgery, since the strongest predictor of persistent postoperative opioid use post-surgery is pre-existing chronic opioid use. The incidence of persistent postoperative opioid use can be up to 10 times higher in those taking opioids long-term before surgery than in patients who have never used opioids.

The main points from the consensus statement are: The authors also highlight the dangers of driving under the influence of opioids, that can impair driving skills and cognitive reasoning in a similar manner to alcohol. "Driving under the influence of drugs, including prescribed opioids, is now recognised to be a major cause of motor vehicle collisions and subsequent fatalities, particularly if the person commenced the opioid within the previous 30 days," explain the authors, who add that many countries have established laws making driving under the influence of opioids illegal.

They conclude: "While the use of opioids during and after surgery has the capacity to promote recovery after life-saving or life-enhancing surgery, their use can be associated with harm from persistent postoperative opioid use; opioid-induced respiratory impairment; opioid diversion to people they were not originally prescribed for; and driving under the influence of prescription opioids. Strict control of opioid use within hospitals (stewardship) is required to minimise the risk of opioid-related harm. This will require the multidisciplinary involvement of anaesthetists; surgeons; pain specialists; pharmacists; nursing staff; physiotherapists; primary care clinicians; hospital management; and patients to adopt the recommendations from this consensus statement to local practice."
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AAGBI

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