Patients who are either persistent opioid users, or are at risk of developing persistent opioid use, should be identified and offered counselling and support in order to taper off opioid treatment following degenerative lumbar surgery. This is according to new research published in the journal Spine by Siril Holmberg and Sasha Gulati (St Olavs University Hospital, Trondheim, Norway) et al.
The prospective pharmacoepidemiological study, which investigated the use of prescription opioids up to two years following degenerative lumbar spine surgery, included data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database on patients who were operated on between 2007 and 2017. The primary outcome measure was persistent opioid use two years after surgery. Functional disability was measured with the Oswestry Disability Index (ODI).
Of the 32,886 study participants, a total of 2,754 (8.4%) met the criteria for persistent opioid use at the second year after surgery. Among these, 64% met the criteria for persistent opioid use the year preceding surgery.
The study found that persistent opioid use the year preceding surgery (odds ratio (OR) 31.10, 95% confidence interval (CI) 26.9-36, p=0.001), use of high doses of benzodiazepines (OR 1.62, 95% CI 1.30-2.04, p=0.001), and use of high doses of z-hypnotics (OR 1.90, 95% CI 1.58-2.22, p=0.001) the year before surgery were associated with increased risk of persistent opioid use during the second year after surgery.
A higher ODI score at one year was observed in persistent opioid users compared to non-persistent users (41.5 vs. 18.8 points) and there was a significant difference in ODI change (-13.7 points). Patients with persistent opioid use in the year preceding surgery were less likely to achieve a minimal clinically important ODI change at one year compared to non-persistent users (37.7% vs. 52.6%, p=0.001).
Speaking to Spinal News International, Holmberg and Gulati said: “The majority of patients with persistent opioid use before surgery were unable to discontinue persistent opioid use. Persistent preoperative opioid use was also associated with inferior patient reported outcomes after surgery. It is a concern that almost half of persistent opioid users received co-medication with high doses of either benzodiazepines or z-hypnotics the second year after surgery.
“It appears that surgery must be accompanied by other interventions to help patients reduce opioid consumption. Our study suggests that patients with or at risk of developing persistent opioid use should be identified and provided counselling and support to taper off opioid treatment.”
“The proportion of patients with persistent opioid use was substantially lower than previously reported in studies from the USA. The explanation is probably multifaceted and may include a more restrictive prescription practice among Norwegian physicians and important differences in patient selection, surgical strategies, prevalence of substance abuse disorders, access to healthcare, and health care organisation.”