Opioid Duration, Not Dosage May Be Key to Reducing Misuse in Surgical Patients

The researchers found that total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with an increased rate of misuse.

A new study indicates that reducing prescription opioid duration, not dosage, may be more effective in curbing misuse after surgery.

According to the study, which was published in the BMJ, overprescribing is thought to be a major contributor to opioid misuse. Because surgical patients are nearly 4 times more likely to receive post-discharge opioids, there is a high risk of potential for addiction. However, the lack of guidance surrounding postsurgical opioid prescribing makes it difficult to determine the best approach to post-discharge opioid prescribing.

For the study, the researchers examined the association between opioid prescription refills after surgery and misuse in an opioid naïve population using data on surgical patients with medical and pharmacy insurance from a database at Aetna. Data included information on nearly 38 million members between 2008 and 2016, and a member was considered to be opioid naïve and eligible for inclusion if his or her total opioid use in the 60 days before surgery was 7 days or less.

According to the data, the researchers found that 56% of surgical patients received postoperative opioids and a code for abuse was identified for 5906 patients. Although rates of misuse were low, it continued to grow rapidly with increasing opioid use, with each week of use associated with a 20% increase in misuse. Rates of misuse more than doubled among those with 1 refill, the researchers noted.

Total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of use associated with an adjusted increase in the rate of misuse of 44% and 19.9% increase in hazard, respectively.

Additionally, the researchers found that, compared with duration of use, the dosage prescribed was a weaker predictor of misuse and dose only became important with extended use.

Overall, the data suggest that patients who require subsequent refills of opioids are more likely to have an episode of misuse, even years after surgery.

The researchers concluded that the findings imply that optimal postoperative prescribing, which maximizes analgesia and minimizes the risk of misuse, may be achieved with moderate to high opioid dosage at short durations. However, further research is needed to determine how initial treatment regimens can minimize misuse and addiction.


Brat GA, Agniel D, Beam A, et al. Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ. 2018. doi: https://doi.org/10.1136/bmj.j5790