When you've had knee surgery, your gallbladder removed, or some other procedure that involves a surgeon cutting into your body, the aftermath is bound to hurt. So it's no wonder that surgery patients often rely on opioids such as Oxycodone, Vicodin, and Percocet for a short time to manage their pain. But a new large-scale study by researchers at Stanford University finds that a few people are unable to stop taking the powerful pain drugs once they've recovered from surgery.
The analysis published in JAMA Internal Medicine, compared the medical records of about 642,000 adults under 65 who underwent a knee replacement or other type of surgery to those of just over 18 million people who didn't. Neither group had taken opioids in the year before the study period.
The researchers found that nearly all the surgeries were associated with a higher risk of "chronic" opioid use—defined as the patient filling 10 or more opioid prescriptions, or receiving more than a four-months' supply of the drugs, in a single year. For surgical patients, researchers didn't count the first three months after surgery.
After that three-month mark, it would be "highly unusual" for someone to still need opioids for pain relief says the study's lead author Eric C. Sun, M.D., Ph.D., an instructor of anesthesiology and pain medicine at the Stanford University School of Medicine in Stanford, California. While complications could have left a small subset of patients with chronic pain, Sun says, "it's also likely that some patients who were vulnerable to opioid dependence ended up taking the drugs long term."
Of the 11 common procedures studied, knee surgery was most likely to lead to long-term opioid use. "Overall, the risk was low; only about 1 out of every 100 patients who had a knee replacement became a chronic opioid user," says Sun. "But that's still a lot of people." Based on the study's findings, an estimated 7,200 Americans a year who weren't taking opioids before knee surgery, wind up taking the drugs for a long time afterward.
Who's at Risk
Prescription painkillers such as oxycodone (Oxycontin and generic), acetaminophen and oxycodone (Percocet and generic), or acetaminophen and hydrocodone (Vicodin and generic) can be as addictive as illicit opioids such as heroin. But even people who are not addicted can become physically dependent on the drugs if they take them continuously for more than two weeks.
So perhaps not surprisingly, the risk for chronic opioid use was higher in people undergoing more extensive surgeries, which could lead to more pain and a longer recovery, than those having minor procedures. For example, regular gallbladder surgery carried a higher risk than the laparoscopic version, where the organ is removed through instruments inserted through small incisions in the abdomen.
Other factors that increased risk included a history of substance abuse or taking an antidepressant or a medication from a class of drugs known as benzodiazepines, which includes anti-anxiety drugs and sedatives such as alprazolam (Xanax and generic), clonazepam (Klonopin and generic), diazepam (Valium and generic), and lorazepam (Ativan and generic).
"Having risk factors for opioid dependence doesn't mean you shouldn't have a needed surgery, or do without pain drugs," says Sun. "It's just something you and your doctors should be aware of when planning your treatment."
Make a Plan to Transition Off Opioids
Most patients undergoing knee surgery or another procedure need to take opioids for pain control for a few days; very few patients will need the drugs longer than a week according to guidelines from the Centers for Disease Control and Prevention (CDC).
Sun advises talking to your doctor upfront about alternatives for ongoing pain relief, including cold packs, local anesthetics, and over-the-counter pain medications such as acetaminophen (Tylenol and generic), ibuprofen (Advil, Motrin IB, and generic), or naproxen (Aleve and generic). Also talk about how soon you can start moving again (often the day of, or the day after, surgery); physical activity can speed recovery and reduce pain.
If you do wind up taking opioids continuously for more than a couple of weeks, stopping the drugs abruptly can trigger withdrawal symptoms such as worsening pain, severe stomach upset, anxiety, and sleeplessness. See our report for advice on how to work with your doctor to create a schedule for tapering off the drugs.
Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
