Medical Student Queen's University Kingston, Ontario, Canada
Background: The opioid crisis remains a public health emergency due to rising opioid-related deaths in Canada. While the majority is due to illicit use, prescription opioids contribute to opioid-related harm. Studies demonstrate that amount and timing of perioperative opioid prescriptions strongly predict persistent opioid use (POU). However, no literature has investigated the association between late prescription and POU. This study sought to characterize POU trends and examine the impact of timing of first opioid prescription after discharge following cardiac surgery on the risk of POU.
METHODS AND RESULTS: Linked administrative registries housed by the Manitoba Centre for Health Policy were used for this study. Adult patients who underwent cardiac surgery via sternotomy between July 1995–March 2023 were identified. Using the Drug Program Information Network database, “opioid-naïve” patients were included in the study, defined as no opioid prescription within 180 days before surgery. Exclusion criteria included hospital stay >14 days post-surgery, minimally invasive surgeries, or an anesthetic procedure within 180 days after surgery. The primary outcome was incidence of POU, defined as filling an opioid prescription within 30 days post-discharge and refilling a prescription between 90-180 days post-discharge. Secondary outcomes included POU trend and the impact of timing of first opioid prescription on POU. Univariate logistic regression was performed and Tukey-Kramer adjustment was used to control for multiple hypothesis testing. There were 25,090 patients who underwent cardiac surgery during the study period, 60% of which (N=15,084) were opioid-naïve. Approximately 40% (N= 5,973) of patients were discharged with opioids. The incidence of POU was 3% (n=510/15,084). POU rate declined from 6% in 1995 to 2% in 2023. Relative to those who received their first opioid prescription within 2 days post-discharge, POU rate was higher in those who received it at 8-14 (p < 0.05), 15-21 (p < 0.01), and 22-30 days (p < 0.001) after discharge (Figure 1). Patients who received their first opioid prescription at 8-14 days (odd ratio, [OR], 2.05; 95% CI 1.42–2.94), 15-21 days (OR 2.49; 95% CI 1.50–4.12), and 22-30 days post-discharge (OR 3.78; 95% CI 2.38–6.00) had increased odds of POU (Figure 1).
Conclusion: Our findings demonstrate that each week of delay in first opioid prescription after cardiac surgery discharge contributes to an increased likelihood of developing POU. Further research should investigate the reasons behind late opioid prescriptions following discharge from cardiac surgery. This can inform the development of targeted interventions aimed at reducing the risk of POU.
