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Weight Loss Surgery Patients at High-Risk for Long-Term Opioid Use


June 08, 2017

According to a recent study, one in five adult patients who undergo weight-loss surgery and were prescribed opioid painkillers continue using them years after surgery.

“Our study does not prove that bariatric surgery causes an increase in opioid use,” study co-author Anita Courcoulas, MD MPH said. “However, it does demonstrate the widespread use of opioids among post-surgical patients, thereby highlighting the need for alternative pain management approaches.”

As the nation continues to struggle with an opioid misuse epidemic, the CDC recently presented evidence-based guidelines explaining that opioids should not be used on a regular basis for chronic pain management. However, the current study found that the rate of patients using opioids is far higher seven years post-surgery compared to when their post-surgical opioid prescription initiated.

In order to determine how weight-loss surgery impacts opioid misuse, the researchers examined more than 2000 patients participating in the NIH-funded Longitudinal Assessment of Bariatric Surgery 2 (LABS-2)—a prospective observational study of patients who underwent weight-loss surgery at one of 10 hospitals across the United States. Of the patients observed, roughly 70% underwent Roux-en-Y gastric bypass which significantly reduces the size of the stomach, and changes the connections with the small intestine. The additional patients observed had the less invasive procedure—laparoscopic adjustable gastric banding—a procedure involving an adjustable band around the stomach.

The researchers reported that 14.7% of patients observed were reportedly taking prescription pain killers prior to surgery. Roughly 6 months after surgery there was a decrease in opioid use to 12.9% of patients, however, 7 years post-surgery the rate of patients using opioids rebounded progressing to 20.3%. The rate for patients who did not take opioids prior to surgery increased from 5.8% at 6 months after surgery to 14.2% 7years later.

The most commonly used opioid among patients was Vicodin (hydrocodone; AbbVie), followed by Ultram (Tremadol; Janssen) and Oxycontin (oxycodone; Purdue Pharma).

“Our nation is in an epidemic of opioid abuse, addiction and overdose,” Dr Courcoulas said. “Recent reports have suggested that bariatric surgery patients are at elevated risk of chronic opioid use.”

The researchers also noted that their findings suggest that the use of opioids was not impacted by typically observed factors, including gender, age, income, social support, or mental health. Rather, they concluded that overuse was due to pain prior to surgery, and a slow improvement in pain following surgery. Further, researchers concluded that starting NSAIDs post-surgery was also associated with a higher risk of starting opioids for some patients; however, 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,” Wendy C King, PhD, study co-author, said. “There is an urgent need for research into adequate alternatives to opioids for the long-term management of chronic pain following weight-loss surgery.”

Julie Gould (Mazurkiewicz)

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